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TUFTS   UNIVERSITY    LIBRARIES 


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Webster  Family  Library  of  Veterinary  Medicine 
Cummings  School  of  Veterinary  Medicine  at 
Tufts  University 
200  Westboro  Road 
North  Grafton,  MA  01 536 


V  E  T  E  R  I  X  A  R  Y       PRACTITIONERS'      SERIES 

N  O.    1 


LAMENESS  of  the  HORSE 

BY 

J.  V.   Lacroix,  D.  V.  S. 

Professor  of  Surgery,  The  Kansas  City  Veterinary  College 
Author  of  "Animal  Castration" 


Illustrated 


Chicago 

AMERICAN  JOURNAL  OF  VETERINARY  MEDICINE 

1916 


Copyright,  1916 

By 

D.  M.  CAMPBELL 


PREFACE 

AH  that  can  be  known  on  the  subject  of  lameness,  is  founded 
on  a  knowledge  of  anatomy  and  of  the  physiology  of  locomotion. 
Without  such  knowledge,  no  one  can  master  the  principles  of 
the  diagnosis  of  lameness.  However,  it  must  be  assumed  that 
the  readers  are  informed  on  these  subjects,  as  it  is  impossible 
to  include  this  fundamental  instruction  in  a  work  so  brief  as 
this  one. 

The  technic  of  certain  operative  or  corrective  procedures,  has 
been  described  at  length  only  where  such  methods  are  not  gener- 
ally employed.  Where  there  is  no  departure  from  the  usual 
methods,  treatment  that  is  essentially  within  the  domain  of  sur- 
gery or  practice  is  not  given  in  specific  detail. 

Realizing  the  need  for  a  treatise  in  the  English  language 
dealing  with  diagnosis  and  treatment  of  lameness,  the  author 
undertook  the  preparation  of  this  manuscript.  That  the  dif- 
ficulties of  depicting  by  means  of  word-pictures,  the  symptoms 
evinced  in  baffling  cases  of  lameness,  presented  themselves  in 
due  course  of  writing,  it  is  needless  to  say. 

It  is  hoped  that  this  volume  will  serve  its  readers  to  the  end 
that  the  handling  of  cases  of  lameness  will  become  a  more  satis- 
factory and  successful  part  of  their  work;  that  both  the  prac- 
titioner and  his  clients  may  profit  thereby;  and  last  but  by  no 
means  least,  that  the  horse,  which  has  given  such  incalculable 
service  to  mankind  and  is  deserving  of  a  more  concrete  reward, 
will  be  benefited  by  the  application  of  the  principles  herein  out- 
lined. 

In  addition  to  the  consultation  of  standard  works  bearing  on 
various  phases  of  the  subject  of  lameness,  the  author  wishes  to 
thankfully  acknowledge  helpful  advice  and  assistance  received 
from  the  publisher.  Dr.  D.  ]\I.  Campbell ;  to  appreciatively  credit 
Drs.  L.  A.  Merillat,  A.  Trickett  and  F.  F.  Brown  for  valuable 
suggestions  given  from  time  to  time.  Particular  acknowledg- 
ment is  made  to  Dr.  Septimus  Sisson,  author,  and  W.  B.  Saun- 
ders &  Co.,  publishers  of  The  Anatomy  of  Domestic  Animals, 
for  permission  to  use  a  number  of  illustrations  from  that  work. 

J.  V.  L. 

Chicago,  Illinois,  October,  1916. 


Justice  shows  a  triumphant  face  at  the  works  of 
humane  practitioners,  ivho  give  serious  thought 
and  expend  honest  effort,  for  the  alleviation  of 
animal  suffering. 


TABLE  OF  CONTENTS 

Page 

Illustrations "^ 

Introduction 11 

SECTION  I 

Etiology   and   Occurrence 15 

Affections  of  Bones 15 

Rarefying  Osteitis,  or  Degenerative  Changes 16 

Fractures    ---  16 

Affections   of   Ligaments 20 

Luxations — Dislocations  21 

Arthritis   22 

Affections  of  Bursae  and  Thecae 27 

Affections  of  Muscles  and  Tendons 28 

Affections  of  Nerves 30 

Affections  of  Blood  Vessels   31 

Affections  of  Lymph  Vessels  and  Glands 32 

Affections  of  the  Feet 34 

SECTION  II 

Diagnostic  Principles 37 

Anamnesis  38 

Visual  Examination  39 

Attitude  of  the  Subject 41 

Examination  by  Palpation 43 

Passive  Movements  47 

Observing  the  Character  of  the  Gait 48 

Special  Methods  of  Examination 53 

SECTION  III 
Lameness  in  the  Fore  Leg 

Anatomo-Physiologieal  Review  of  Parts  of  the  Fore  Leg 55 

Shoulder  Lameness  61 

Fracture  of  the  Scapula 62 


Page 

Scapulohumeral  Arthritis 65 

Infectious  Arthritis 66 

Injuries 66 

Wounds 67 

Luxation  of  the  Scapuloluuneral  Joint 67 

Inflammation  of  the  Bicipital  Bursa 68 

Contusions  of  the  Triceps  Brachii 71 

Shoulder  Atrophy   (Sweeny) 73 

Paralysis  of  the  Suprascapular  Nerve 75 

Radial  Paralysis  _ 77 

Thrombosis  of  the  Brachial  Artery 81 

Fracture  of  the  Humerus 82 

Inflammation  of  the  Elbow 84 

Fracture  of  the  Ulna _. 86 

Fracture  of  the  Radius 87 

Wounds  of  the  Anterior  Brachial  Region 90 

Inflammation  and  Contraction  of  the  Carpal  Flexors 93 

Fracture  and  Luxation  of  the  Carpal  Bones 96 

Carpitis 98 

Open  Carpal  Joint 100 

Thecitis  and  Bursitis 104 

Fracture  of  the  INIetacarpus 106 

Splints  107 

Open  Fetlock  Joint -- 110 

Phalangeal  Exostosis   (Ring'l)one) 118 

Open  Sheath  of  the  Flexors  of  the  Phalanges 124 

Luxation  of  the  Fetlock  Joint 125 

Sesamoiditis   127 

Fracture  of  the  Proximal  Sesamoids 128 

Inflammation   of   the    Posterior   Ligaments   of   the    Pastern. 

Proximal  Interphalangeal  Joint 129 

Fracture  of  the  First  and  Second  Phalanges ...131 

Tendinitis  (Inflammation  of  the  Flexor  Tendons).. 135 

Chronic  Tendinitis  and  Contraction  of  the  Flexor  Tendons.. ..137 

Contracted  Tendons  of  Foals..^ 143 

Rupture  of  the  Flexor  Tendons  and  Suspensory  Ligament...  146 
Tliecitis  and  Bui-sitis  in  the  P^etloek  Region 150 


Page 

Arthritis  of  the  Fetlock  Joint 152 

Ossification  of  the  Cartilages  of  the  Third  Phalanx ....155 

Navicular  Disease  157 

Laminitis  -- IGO 

Calk  Wounds   (Paronychia) 170 

Corns -. 172 

Quittor 174 

Nail  Punctures  178 

SECTION  IV 

Lameness  in  the  Hind  Leg 

Anatomo-Physiological  Consideration  of  the  Pelvic  Limhs....l85 

Hip  Lameness 19'5 

Fractures  of  the  Pelvic  Bones 196 

Fractures  of  the  Femur 199 

Luxation  of  the  Femur 201 

Gluteal   Tendo-Synovitis   203 

Paralysis  of  the  Hind  Leg -204 

Paralysis  of  the  Femoral  (Crural)  Nerve 204 

Paralysis  of  the  Obturator  Nerve 206 

Paralysis  of  the  Sciatic  Nerve 208 

Iliac  Thrombosis - 209 

Fracture  of  the  Patella 212 

Luxation  of  the  Patella.. 213 

Chronic  Gonitis 217 

Open  Stifle  Joint 220 

Fracture  of  the  Tibia  222 

Rupture  and  AVounds  of  the  Tendo  Achillis... 224 

Spring-Halt  (String-Halt)    ..: 225 

Open  Tarsal  Joint  229 

Fracture  of  the  Fibular  Tarsal  Bone  (Calcaneum) 230 

Tarsal    Sprains    232 

Curb    233 

Spavin    (Bone  Spavin) 235 

Distension  of  the  Tarsal  Joint  Capsule  (Bog  Spavin) 242 

Distension  of  the  Tarsal  Sheath  of  the  Deep  Digital  Flexor 

(Thoroughpin)    246 


Page 

Capped  Hock 251 

Rupture  and  Division  of  the  Long  Digital    Extensor    (Ex- 
tensor Pedis)   - 2.53 

Wounds  from  Interfering 255 

Lymphangitis  257 

Authorities  Cited 265 

Index  .- 267 


ILLUSTRATIONS 

Page 

Fig.     1  Hoof  Testers  53 

Fig.     2 — Muscles  of  Left  Thoracic  Limb,  Lateral  View 56 

Fig.     3 — ]\Iiiscles  of  Left  Thoracic  Limb,  Medial  View 57 

Fig.     4 — Sagital  Section  of  Digit  and  Distal  Part  of  Meta- 
carpus      59 

Fig.     5 — Ordinary  Type  of  Heavy  Sling 62 

Fig.     6— A  Sling  Made  in  Two  Parts 63 

Fig.     7 — Paralysis    of    the    Suprascapular    Nerve    of    Left 

Shoulder   76 

Fig.     8— Radial  Paralysis 78 

Fig.     9 — Merillat's    ]\Iethod    of    Fixing    Carpus    in    Radial 

Paralysis 79 

Fig.  10 — Contraction  of  Carpal  Flexors,  "Knee  Sprung"....  95 
Fig.  11 — Pericarpal  Inflammation  and  Enlargement  Due  to 

Injury   99 

Fig.  12 — Hygromatous  Condition  of  the  Right  Carpus 100 

Fig.  13 — Carpal  Exostosis  in  x\ged  Horse 101 

Fig.  14 — Exostosis  of   Carpus  Resultant  from   Carpitis 102 

Fig.  15 — Distal    End    of    Radius,     Illustrating    Effects    of 

Carpitis  102 

Fig.  16 — Posterior  View  of  Radius,   Illustrating  Effects  of 

Splint    108 

Fig.  17 — Phalangeal  Exostoses  120 

Fig.  18 — Rarefying  Osteitis  in  Chronic  Ringbone 121 

Fig.  19 — Phalangeal  Exostoses  in  Chronic  Ringbone 122 

Fig.  20 — Contraction  of  Superficial  Digital  Flexor  Tendon 

Due  to  Tendinitis  138 

Fig.  21 — Contraction     of     Deep     Flexor     Tendon     Due     to 

Tendinitis   139 

Fig.  22 — Chronic  Case  of  Contraction  of  Both  Flexor  Ten- 
dons  of   the   Phalanges 140 

Fig.  23 — Contraction  of  Superficial  and  Deep  Flexor  Ten- 
dons   ...141 


Page 
Fig.  24 — Contraction    of    Superficial    Digital    Flexor    and 

Slight  Contraction  of  Deep  Flexor  Tendon 142 

Fig.  25— "Fish   Knees"   145 

Fig.  26 — Extreme   Dorsal   Flexion 146 

Fig.  27 — A  Good  Style  of  Shoe  for  Bracing  the  Fetlock 148 

Fig.  28 — The  Roberts  Brace  in  Operation 149 

Fig.  29 — Distension  of  Theca  of  Extensor  of  the  Digit 151 

Fig.  30 — Rarefying    Osteitis    Wherein    Articular    Cartilage 

Was  Destroyed 153 

Fig.  31 — Ringbone  and  Sidebone 156 

Fig.  32 — Position    Assumed    by    Horse    Having    Unilateral 

Navicular  Disease ..159 

Fig.  33 — The  Hoof  in  Chronic  Laminitis 165 

Fig.  34— Effects  of  Laminitis 166 

Fig.  35 — Cochran  Shoe,  Inferior  Surface 168 

Fig.  36 — Cochran  Shoe,  Superior  Surface 169 

Fig.  37 — Hyperplasia   of   Right   Forefoot   Due   to    Chronic 

Quittor 176 

Fig.  38— Chronic  Quittor,  Left  Hind  Foot 177 

Fig.  39— Skiagraph  of  Foot 179 

Fig.  40— Sagital  Section  of  Right  Hock 186 

Pig.  41 — Muscles  of  Right  Leg;  Front  View 187 

Fig.  42— Muscles  of  Lower  Part  of  Thigh,  Leg  and  Foot 189 

Fig.  43— Right  Stifle  Joint;  Lateral  View .....190 

Fig.  44— Left  Stifle  Joint;  I\Iedial  View 191 

Pig.  45— Left  Stifle  Joint;  Front  View 193 

Fig.  46 — Oblique  Fracture  of  the  Femur 200 

Fig.  47 — Fracture  of  Femur  After  Six  Months'  Treatment..201 
Fig.  48 — Aorta    and    Its    Branches    Showing    Location    of 

Thrombi    210 

Fig.  49 — Thrombosis  of  the  Aorta,  Iliacs  and  Branches 211 

Fig.  50— Chronic  Gonitis 218 

Fig.  51 — Position  Assumed  in  Gonitis 219 

Fig.  52— Spring-halt    -226 

Fig.  53 — Lateral  View  of  Tarsus  Showing  Effects  of  Tar- 

sitis    228 

Fig.  54— Right  Hock  Joint 231 

Fig.  55 — Spavin    -235 


Page 

Fig.  56 — Bog  Spavin  243 

Fig.  57 — Thoroughpin  247 

Fig.  58 — Fibrosity  of  Tarsus  in  Chronic  Thoroughpin 248 

Fig.  59 — Another  View  of  Case  Shown  in  Fig.  58 249 

Fig.  60— "Capped  Hock"   252 

Fig.  61 — Chronic  Lymphangitis  258 

Fig.  62— Elephantiasis 259 


INTRODUCTION 

Lameness  is  a  symptom  of  an  ailment  or  affection  and  is  not 
to  be  considered  in  itself  as  an  anomalous  condition.  It  is  the 
manifestation  of  a  strnctural  or  fnnctional  disorder  of  some  part 
of  the  loeomotory  apparatus,  characterized  by  a  limping  or  halt- 
ing gait.  Therefore,  any  affection  causing  a  sensation  and 
sign  of  pain  which  is  increased  by  the  bearing  of  weight  upon 
tbe  aff'ected  member,  or  by  the  moving  of  such  a  distressed  part, 
results  in  an  irregularity  in  locomotion,  which  is  known  as  lame- 
ness or  claudication.  A  halting  gait  may  also  be  produced  by 
the  abnormal  development  of  a  member,  or  by  the  shortening  of 
the  leg  occasioned  by  the  loss  of  a  shoe. 

For  descriptive  purposes  lameness  may  be  classified  as  true  and 
false.  True  lameness  is  such  as  is  occasioned  by  structural  or 
functional  defects  of  some  part  of  the  apparatus  of  locomotion, 
such  as  would  be  caused  by  spavin,  ring-bone,  or  tendinitis.  False 
lameness  is  an  impediment  in  the  gait  not  caused  l)y  structural 
or  functional  disturbances,  but  is  brought  on  by  conditions  such 
as  may  result  from  the  too  rapid  driving  of  an  unbridle- wise 
colt  over  an  irregular  road  surface,  or  by  urging  a  horse  to  trot 
at  a  pace  exceeding  the  normal  gait  of  the  animal's  capacity, 
causing  it  to  "crow-hop"  or  to  lose  balance  in  the  stride.  The 
latter  manifestation  might,  to  the  inexperienced  eye,  simulate 
true  lameness  of  the  hind  legs,  but  in  reality,  is  merely  the  re- 
sult of  the  animal  having  been  forced  to  assume  an  abnormal  pace 
and  a  lack  of  balance  in  locomotion  is  the  consequence. 

The  degree  of  lameness,  though  variable  in  different  instances, 
is  in  most  cases  proportionate  to  the  causative  factor,  and  this 
fact  serves  as  a  helpful  indicator  in  the  matter  of  establishing  a 
diagnosis  and  giving  the  prognosis,  especially  in  cases  of  some- 
what unusual  character.  An  animal  may  be  slightly  lame  and 
the  exhibition  of  lameness  be  such  as  to  render  the  cause  baf- 
flingly  obscure.  Cases  of  this  nature  are  sometimes  quite  diffi- 
cult to  classify  and  in  occasional  instances  a  positive  diagnosis 
is  impossible.     Subjects  of  this  kind  may  not  be  sufficiently  in- 


convenienced  to  warrant  their  being  taken  out  of  service,  yet  a 
lame  horse,  no  matter  how  slightly  affected,  should  not  be  con- 
tinued in  service  unless  it  can  be  positively  established  that  the 
degree  of  discomfort  occasioned  by  the  claudication  is  small  and 
the  work  to  be  done  by  the  animal,  of  the  sort  that  will  not 
aggravate  the  condition. 

Subjects  that  are  very  lame — so  lame  that  little  weight  is 
borne  by  the  affected  member — are,  of  course,  unfit  for  service 
and  as  a  rule  are  not  difficult  of  diagnosis.  For  instance,  a  frac- 
ture of  the  second  phalanx  would  cause  much  more  lameness  than 
an  injury  to  the  lateral  ligament  of  the  coronary  joint  wherein 
there  had  occurred  only  a  slight  sprain,  and  though  crepitation 
is  not  recognized,  the  diagnostician  is  not  justified  in  excluding 
the  possibility  of  fracture,  if  the  lameness  seems  disproportion- 
ate to  the  apparent  first  cause. 

The  course  taken  by  cases  of  lameness  is  as  variable  as  the 
degree  of  its  manifestation,  and  no  one  can  definitely  predict  the 
duration  of  any  given  cause  of  claudication. 

Because  of  the  fact  that  horses  are  not  often  good  self -nurses 
at  best,  and  that  it  is  difficult  to  enforce  proper  care  for  the  parts 
affected,  one  can  not  wisely  state  that  resolution  will  promptly 
follow  in  an  acute  involvement,  nor  can  he  predict  that  the  case 
will  or  will  not  become  chronic.  Experience  has  proved  that 
complete  or  partial  recovery  may  result,  or  again,  that  no  change 
may  occur  in  any  given  case,  and  that  in  some  instances  even 
where  rational  treatment  is  early  administered,  a  decided  aggra- 
vation of  the  condition  may  follow  unaccountably. 

However,  because  of  the  economic  element  to  be  reckoned  with, 
it  is  of  some  value  to  be  able  to  give  a  fairly  accurate  prognosis 
in  the  handling  of  cases  of  lameness,  as  in  the  majority  of  in- 
stances the  treatment  and  manner  of  after-care  are  determined 
largely  by  the  expense  that  any  prescribed  line  of  attention  will 
occasion. 

A  case  of  acute  bone  spavin  in  a  horse  of  little  value  is  not 
generally  treated  in  a  manner  that  will  incur  an  expense  equiva- 
lent to  one-half  the  value  of  the  subject.  The  fact  is  always  to 
be  considered  in  such  cases,  that  even  where  ideal  conditions  favor 
proi)er  treatment,  the  outcome  is  uncertain.     Where  less  than 


six  weeks  of  rest  can  be  allowed  the  animal,  one  affected  with 
bone  spavin  would  therefore  not  be  treated  with  the  expectation 
of  obtaining  good  results,  as  six  weeks'  time,  at  least,  is  necessary 
for  a  successful  outcome.  If  the  cost  attending  the  enforced 
idleness  of  an  animal  of  this  kind  is  considered  prohibitive  for 
the  employment  of  proper  measures  to  affect  a  cure,  and  if  lame- 
ness is  slight,  the  animal  should  be  given  suitable  work,  but  in 
eases  of  articular  spavin  in  aged  subjects,  they  should  be  hu- 
manely destroyed  and  not  subjected  to  prolonged  misery. 

A  thorough  knowledge  of  the  structure  and  functions  of  the 
affected  parts  is  necessary  to  proceed  in  cases  of  lameness ;  like- 
wise, the  age,  conformation  and  temperament  of  the  subject  need 
to  be  taken  into  consideration;  the  presence  or  absence  of  com- 
plications demand  the  attention;  the  kind  of  care  the  subject 
will  probably  receive  directly  influences  the  outcome;  and  the 
character  of  service  expected  of  the  subject,  too,  needs  to  be 
carefully  considered  before  the  ultimate  outcome  may  reasonably 
be  foretold. 

The  practitioner  is  often  confronted  with  the  prolilem  of  how 
best  to  handle  certain  cases.  Will  they  do  better  under  condi- 
tions Avhere  absolute  quiet  is  enforced,  or  is  it  preferable  to  allow 
exercise  at  will?  The  temperament  of  the  animal  must  be  con- 
sidered in  such  cases,  and  if  a  lame  horse  is  too  active  and  play- 
ful when  given  his  freedom,  exercise  must  be  restricted  or  pre- 
vented, as  the  ease  may  require.  In  cases  of  strains  of  tendons, 
during  the  acute  stage,  immobilization  of  the  affected  parts  is  in 
order.  In  certain  sub-acute  inflammatory  processes  or  in  in- 
stances of  paralytic  disturbance  where  convalescence  is  in  prog- 
ress, moderate  exercise  is  highly  beneficial. 

Consequently,  each  case  in  itself  presents  an  individual  jn-ob- 
lem  to  be  judged  and  handled  in  the  manner  experience  has 
taught  to  be  most  effective,  appropriate  and  practical,  and  the 
veterinarian  should  give  due  consideration  to  the  comfort  and 
welfare  of  the  crippled  animal  as  well  as  to  the  interests  of  the 
owner. 


SECTION  I. 
ETIOLOGY  AND  OCCURRENCE. 

In  discussions  of  pathological  conditions  contributing  to  lame- 
ness in  the  horse,  cause  is  generally  classified  under  two  heads — 
predisposing  and  v.rcllinn.  It  becomes  necessary,  however,  to 
adopt  a  more  general  and  comprehensive  method  of  classification, 
herein,  which  will  enable  the  reader  to  obtain  a  better  conception 
of  the  subject  and  to  more  clearly  associate  the  parts  so  grouped 
descriptively. 

Though  predisposing  factors,  such  as  faulty  conformation,  are 
often  to  be  reckoned  with,  exciting  causes  predominate  more  fre- 
quently in  any  given  number  of  cases.  The  noble  tendency  of 
the  horse  to  serve  its  master  under  the  stress  of  pain,  even  to 
the  point  of  complete  exhaustion  and  sudden  death,  should  win 
for  these  willing  servants  a  deeper  consideration  of  their  welfare. 
Too  frequently  are  their  manifestations  of  discomfort  allowed 
to  pass  unheeded  ])y  careless,  incompetent  drivers  lacking  in  a 
sense  of  compassion.  Symptoms  of  malaise  should  never  be 
ignored  in  any  case;  the  humane  and  economic  features  should 
be  realized  by  any  owner  of  animals. 

In  the  consideration  of  group  causes,  lameness  may  be  said 
to  originate  from  affections  of  bones,  ligaments,  thecae  and  bur- 
sae,  muscles  and  tendons,  nerves,  lymph  vessels  and  glands,  and 
blood  vessels,  and  may  also  result  from  an  involvement  of  one  or 
several  of  the  aforementioned  tissues,  caused  by  rheumatism. 
Further,  affections  of  the  feet  merit  separate  consideration,  and, 
finally,  a  miscellaneous  grouping  of  various  dissimilar  ailments, 
which  for  the  most  part,  do  not  directly  involve  the  locomotory 
a]i]iaratus  l)ut  do.  by  their  nature,  impede  normal  movement. 

AFFECTIONS  OF  BONES. 

The  bony  coliuini  serving  as  the  framework  and  support  of 
the  legs,  probably  constitutes  the  most  vital  element  having  to 
do  with  weight  bearing  and  locomotion,  and  therefore  during 
the  acute  and  painful  stage  of  bone  affections,  the  pain  becomes 

15 


16  LAMENESS  OF  THE  HORSE 

more  intense  in  the  process  and  pressure  of  standing  than  when 
the  mem])er  is  swung  or  advanced. 

Certain  bones  are  so  well  protected  by  muscular  structures 
that  they  are  not  frequently  injured  except  as  a  result  of  vio- 
lence w'hich  may  produce  fracture.  However,  there  are  certain 
bones  which  receive  the  constant  shock  of  concussion  when  the 
animal  is  subjected  to  daily,  rapid  work  on  hard  road  surfaces. 
Splints,  ringbones  and  spavins  are  the  most  general  examples 
produced  by  these  conditions. 

Varying  pathological  developments  often  result  from  concus- 
sion, contusion  or  other  violent  shocks  to  the  bony  structuras. 
In  such  cases  there  either  follows  a  simple  periostitis  which  may 
resolve  spontaneously  with  no  obvious  outward  symptom,  or 
osteitis,  which  may  occur  with  tissue  changes,  as  in  exostosis;  or 
the  case  may  produce  any  degree  of  reaction  between  these  two 
])Ossible  extremes. 

Rarefying  Osteitis,  or  Degenerative  Changes. 

Certain  bone  alfections,  such  as  osteonudacia  or  osteoporosis, 
are  in  the  main,  responsible  for  distortions  and  morphological 
changes  of  bone,  causing  lameness,  permanent  blemish  and  even 
resulting  in  death  of  the  affected  animal.  The  climatic  condi- 
tions in  some  localities  favor  these  occurrences  but  they  may 
also  be  ascribed  to  improper  food  constituents  and  to  possible 
infective  agencies. 

Rarefying  degenerative  changes  manifested  by  exostosis  involv- 
ing the  phalanges  of  the  young,  causing  ringbone,  are  fairly  com- 
mon in  occurrence  throughout  this  country.  This  is  due,  sup- 
posedly, to  a  lack  of  mineral  substance  in  the  bony  structure  of 
the  affected  animals,  and  is  known  as  rachitis — commonly  called 
rickets.  Since  the  affected  subjects  suffer  involvement  of  several 
of  the  extremities  at  the  same  time,  the  theory  of  rachitic  origin 
seems  well  supported. 

Fractures. 

Fractures  of  bones  constitute  serious  conditions  and  are  always 
manifested  by  lameness.     A  sub-classification  is  essential  here 


ETIOLOGY  AND  OCCURRENCE  1? 

for  the  student  of  veterinary  medicine  who  would  comprehend 
the  technic  of  reduction  and  subsequent  treatment  in  such 
cases. 

Fractures  are  classified  by  many  authorities  as  being  simple, 
compound,  and  comminuted.  This  method  is  practical  because 
it  separates  dissimilar  conditions.  There  are  also  grouped  frac- 
tures, the  pathologic  anatomy  of  which  is  similar.  Classification 
on  an  etiological  basis  would  attempt  to  associate  conditions, 
the  morbid  anatomy  and  gravity  of  which  would  justly  preclude 
their  being  combined. 

Simple  Fracture  is  a  condition  where  the  continuity  of  the 
bone  has  been  broken  without  serious  destruction  of  the  soft 
structures  adjacent,  and  where  no  opening  has  been  made  to  the 
surface  of  the  flesh.  Such  fractures  do  not  reduce  the  bone  to 
fragments.  Long  bones  are  frequently  subjected  to  simple  frac- 
ture, while  short  thick  bones,  such  as  the  second  phalanx,  may 
suffer  multiple  or  comminuted  fractures. 

Compound  Fracture  designates  a  break  of  bone  with  the 
destruction  of  the  soft  tissues  covering  it,  making  an  open  wound 
to  the  surface  of  the  skin.  This  form  of  fracture  is  serious 
because  of  the  attendant  danger  of  infection,  and  in  treatment, 
necessitates  special  precaution  being  taken  in  the  application  of 
splints  that  the  wound  may  be  cared  for  without  infection  of  the 
tissues.  These  fractures  generally  occur  as  a  result  of  some 
forceful  impact  through  the  flesh  to  the  bone,  or  where  the  bones 
are  driven  outward  by  the  blow.  Common  examples  are  in  frac- 
tures of  the  metacarpus  and  metatarsus  of  the  first  phalanx. 
This  kind  of  injury  in  mature  horses  usually  produces  an  ir- 
reparable condition,  and  viewed  economically,  is  generally  con- 
sidered fatal. 

Comminuted  Fractures,  as  the  term  implies,  are  those  cases 
wherein  the  bone  is  reduced  to  a  number  of  small  pieces.  This 
kind  of  break  may  be  classified  as  simple-comminuted  fracture 
when  the  skin  is  unbroken,  and  when  the  bone  is  exposed  as  a 
result  of  the  injury,  it  is  known  as  a  compound-comminuted 
fracture.  Such  fractures  are  caused  by  violent  contusion  or 
where  the  member  is  caught  between  two  objects  and  crushed. 


18  LAMENESS  OP  THE  HORSE 

Multiple  Fractures. 

Fractures  are  called  multiple  when  the  bone  is  reduced  to  a 
number  of  pieces  of  large  size.  This  condition  differs  from  a 
comminuted  fracture  in  that  the  multiple  fracture  may  break 
the  bone  into  several  pieces  without  the  pieces  being  ground  or 
crushed,  and  the  affected  bone  may  still  retain  its  normal  shape. 

Further  classification  is  of  value  in  describing  fractures  of 
bone  with  respect  to  the  manner  in  which  the  bone  is  broken — 
the  direction  of  the  fissure  or  fissures  in  relation  to  its  long 
axis. 

A  fracture  is  transverse  when  the  bone  is  broken  at  a  right 
angle  from  its  long  axis.  Such  breaks  when  simple,  are  the  least 
trouble  to  care  for  because  there  is  little  likelihood  that  the 
broken  ends  of  bone  will  become  so  displaced  that  they  will  not 
remain  in  apposition.  Simple  transverse  fracture  of  the  meta- 
carpus, for  instance,  constitutes  a  favorable  case  for  treatment 
if  other  conditions  are  favorable. 

Otlique  fractures,  as  may  be  surmised,  are  solutions  of  con- 
tinuity of  bone  in  such  manner  that  the  fissure  crosses  the  long 
axis  of  a  bone  at  an  acute  or  obtuse  angle.  These  fractures  are 
prone  to  injure  the  soft  structures  adjacent,  and  are  frequently 
compound,  as  well.  IMoreover,  because  of  the  fact  that  the  ap- 
posing pieces  of  bone  are  beveled,  the  broken  ends  of  bone  are 
likely  to  pass  one  another  in  such  a  way  as  to  shorten  the  dis- 
tance between  the  extremities  of  the  injured  member.  Con- 
traction of  muscles  also  tends  to  exert  traction  upon  a  bone  so 
fractured,  resulting  in  a  lateral  approximation  of  the  diaphysis 
and  thus  preventing  union  because  the  broken  surfaces  are  not 
in  proper  contact. 

Fractures  are  longiiudinal  when  the  fissure  is  parallel  with 
the  long  axis  of  the  bone.  This  variety  of  break  is  not  infre- 
quent in  the  first  phalanx ;  and  a  vertical  fracture  of  the  second 
phalanx  is  also  said  to  be  longitudinal,  however,  there  is  little 
difference  (if  any,  in  some  subjects)  between  the  vertical  and 
transverse  diameters  of  this  particular  bone. 

Green  stick  fractures  are  essentially  those  resulting  from  falls 
to  young  animals.     Thej^  are  usuallj^  sub-periosteal  and  when 


ETIOLOGY  AND  OCCURRENCE  19 

the  periosteum  is  left  intact  or  nearly  so,  no  crepitation  is  dis- 
cernible. If  this  fracture  is  simple,  prompt  recovery  may  be  ex- 
pected. Bones  of  young  animals,  because  they  do  not  contain 
proportionately  as  much  mineral  substance  as  do  bones  of  adults, 
are  more  resilient  and  less  apt  to  become  completely  fractured. 
They  are,  however,  subject  to  what  is  known  as  green  stick 
fracture. 

Impacted  fractures  are  usually  occasioned  by  falls.  When  the 
weight  of  the  body  is  suddenly  caught  by  a  member  in  such  man- 
ner as  to  forcefully  drive  the  epiphyseal  portions  of  bone  into 
and  against  the  diaphysis,  niultiple  longitudinal  fractures  occur 
at  the  point  of  least  resistance.  Parts  so  affected  undergo  a 
fibrillary  separation,  increasing  the  transverse  diameter  of  the 
bone;  or  if  the  impact  has  been  sufficiently  violent,  the  portion 
becomes  an  amorphous  mass. 

In  a  treatise  on  the  subject  of  lameness,  the  bones  chiefly  con- 
cerned and  most  often  affected  must  be  especially  considered. 
The  shape  and  size  of  a  bone  when  injured,  determines  in  a 
measure,  the  course  and  probable  outcome  in  most  cases,  but  of 
first  and  greater  importance  is  the  function  of  the  bone.  A  frac- 
ture of  the  fibula  in  the  horse  need  not  incapacitate  the  subject, 
but  a  tibial  fracture  is  serious  and  generally  proves  cause  for 
fatal  termination.  The  body  of  the  scapula  may  be  completely 
fractured  and  recovery  will  probably  result  in  most  cases  without 
much  attention  being  given  to  the  sul)ject,  yet  a  fracture  of  the 
neck  of  this  same  bone  constitutes  an  injury  of  serious  conse- 
quence. The  difference  in  the  function  of  different  parts  of  this 
same  bone,  as  well  as  its  shape  and  mode  of  attachment,  deter- 
mine the  gravity  of  the  case ;  so  it  is  in  fractures  of  other  bones 
with  respect  to  the  course  and  prognosis  of  the  case — function 
is  the  important  factor  to  be  considered. 

Next  in  importance  is  the  age  of  the  animal  suffering  fracture 
of  the  bone.  Capacity  for  regeneration  is  naturally  greater  in 
a  vigorous,  young  animal  than  in  aged  or  even  middle-aged  sub- 
jects. A  healthy  condition  of  the  bone  and  the  body  favor  the 
process  of  repair  in  case  of  fracture,  and  prognosis  may  be  favor- 
able or  unfavorable,  depending  upon  these  factors  mentioned  for 
consideration.     Individuals  of  the  same  species,  differing  in  tem- 


20  LAMENESS  OF  THE  HORSE 

perament,  may  comport  themselves  in  a  manner  that  is  conductive 
to  prompt  recovery,  or  to  early  destruction.  This  feature  cannot 
be  overestimated  in  importance,  as  it  is  sometimes  a  decisive 
element,  regardless  of  other  conditions.  A  horse  suffering  from 
an  otherwise  remediable  pelvic  fracture  may  be  so  worried  and 
tortured  by  being  confined  in  a  sling  that  the  case  calls  for  spe- 
cial attention  and  care  because  of  the  animal's  temperament. 
Sometimes,  the  constant  presence  of  a  kind  attendant  will  so 
reassure  the  subject  that  it  will  become  resigned  to  unnatural 
confinement,  in  a  day  or  two.  This  precaution  may,  in  itself, 
determine  the  outcome,  and  the  wise  veterinarian  will  not  over- 
look this  feature  or  fail  to  deviate  from  the  usual  rote  in  the 
handling  of  average  cases.  Recovery  may  be  brought  about  in 
irritable  subjects  by  this  concession  to  the  individual  idiosyn- 
crasies of  such  animals. 

AFFECTIONS  OF  LIGAMENTS. 

Ligaments  which  have  to  do  with  the  locomotory  apparatus 
are,  for  the  most  part,  inelastic  structures  which  are  composed 
of  white  fibrous  tissue  and  serve  to  join  together  the  articular 
ends  of  bones ;  to  bind  down,  tendons ;  and  to  act  as  sheathes  or 
grooves  through  which  tendons  pass,  and  as  capsular  membranes 
for  retention  of  synovia  in  contact  with  articular  surfaces  oP 
bones. 

Ligaments  are  injured  less  frequently  than  are  bones.  Because 
of  their  flexibility  they  escape  fracture  in  the  manner  that  bones 
suffer.  They  are,  however,  completely  severed  by  being  cut  or 
ruptured,  though  fibrillary  fracture  the  result  of  constant  or 
intermittent  tensile  strain  is  of  more  frequent  occurrence. 

Simple  inflammation  of  ligaments  is  of  occasional  occurrence 
but,  unless  considerable  injury  is  done  this  tissue,  no  perceptible 
manifestation  of  injury  results.  No  doul^t  many  cases  wherein 
fibrillary  fracture  of  ligaments  (sprain)  takes  place  some  lame- 
ness is  caused,  but  because  of  the  dense,  comparatively  non- 
vascular nature  of  these  structures,  little  if  any  manifestation, 
except  lameness,  is  evident.  And  such  eases,  if  recognized  are 
usually  diagnosed  by  excluding  the  existence  of  other  possible 
causes  and  conditions  wliidi  miti'lit  also  cause  lameness. 


ETIOLOGY  AND  OCCURRENCE  21 

Certain  ligaments  are  subjected  to  strain  more  than  are  others 
and  therefore,  when  so  involved,  frequently  cause  lameness.  Ex- 
amples of  this  kind  are  affections  of  the  collateral  (lateral)  liga- 
ments of  the  phalanges.  Because  of  the  leverage  afforded  by  the 
transverse  diameter  of  the  foot,  when  an  animal  is  made  to  travel 
over  uneven  road  surfaces,  considerable  strain  is  brought  to  bear 
on  the  collateral  ligaments  of  the  phalanges.  A  sequel  to  this 
form  of  injury  is  a  circumscribed  periostitis  at  the  site  of  at- 
tachment of  the  ligaments  and  frequently  the  formation  of  an 
exostosis — ringbone — results. 

Where  sudden  and  violent  strain  is  placed  upon  a  ligament 
and  rupture  occurs,  the  division  is  usually  effected  by  the  liga- 
ment being  torn  from  its  attachment  to  the  bone.  In  such  cases, 
a  portion  of  periosteum  and  bone  is  usually  detached  and  the 
condition  may  then  properly  be  called  one  of  fracture.  In  some 
cases  of  this  kind  recovery  is  tardy,  because  of  the  difficulty 
in  maintaining  perfect  apposition  of  the  divided  structures,  and 
reactionary  inflammation  is  not  of  sufficient  extent  to  enhance 
prompt  repair.  In  fact,  some  cases  of  this  kind  seem  to  progress 
more  favorably,  when  no  attempt  at  immobilization  of  the  af- 
fected member  is  attempted. 

If  some  freedom  of  movement  is  allowed,  acute  inflammation 
resulting  in  nature's  provisional  swelling  soon  develops  and 
repair  is  hastened  because  of  increased  vascularity.  But  where 
luxation  of  phalanges  accompanies  sprain,  reposition  and  immo- 
bilization are  necessary — that  is  if  cases  are  thought  likely  to 
benefit  by  any  treatment. 

Luxations — Dislocations. 

Luxation  or  dislocation  is  a  condition  where  the  normal  rela- 
tion between  articular  ends  of  bones  has  been  deranged  to  the 
extent  that  partial  or  complete  loss  of  function  results.  When  a 
bone  is  luxated  (out  of  joint),  there  has  occurred  a  partial  or 
complete  rupture  of  certain  ligaments  or  tendons;  or  a  bone 
may  be  luxated  when  an  abnormal  or  unusual  elasticity  of  inhib 
itory  ligaments  or  tendons  obtains. 

Luxations  may  be  practically  classified  as  temporarij  and  fixed. 
In  temporary  luxations,  disarticulation  is  but  momentary  and 


22  LAMENESS  OP  THE  HORSE 

spontaneous  reposition  always  results ;  while  a  fixed  luxation  does 
not  reduce  spontaneously  but  remains  luxated  until  reposition 
is  effected  by  proper  manipulation  and  treatment.  Fixed  luxa- 
tion may  be  of  such  character  as  to  be  practically  irreducible 
because  of  extensive  damage  done  to  ligaments  or  cartilage. 
Where  a  complete  luxation  of  the  metacarpophalangeal  joint 
exists,  it  is  probal)le  that  in  most  cases  sufficient  injury  to  col- 
lateral and  capsular  ligaments  has  been  done  to  render  com- 
plete recovery  improbable,  if  not  impossible. 

Temporary  luxation  of  the  patella  is  a  common  affection  of 
tbe  horse  and  fixed  luxation  of  this  bone  also  occurs.  As  a  mat- 
ter of  fact,  in  the  horse,  patellar  luxation  is  tbe  one  frequent 
affection  of  this  kind. 

As  a  rule,  complete  disarticulation  immobilizes  the  affected 
joint  and  in  most  instances  there  is  noticeable  an  abnormal  prom- 
inence in  the  immediate  vicinity — in  patellar  luxation,  the  whole 
bone.  In  other  instances  the  articular  portion  only,  of  the  af- 
fected bone  is  malpositioned.  Usually,  luxation  and  fracture 
may  be  differentiated  in  that  there  is  no  crepitation  in  luxation 
and  more  or  less  crepitation  exists  in  fracture. 

It  is  evident,  when  one  considers  the  symptomatology  and 
nature  of  the  affection,  that  fixed  luxation  is  usually  caused  by 
undue  strain  or  violent  and  abnormal  movement  of  a  part. 
Joints  having  the  greater  freedom  of  movement  are  apt  to  suffer 
luxation  more  frequently. 

Arthritis. 

The  study  of  arthritis  in  the  horse  is  limited  to  a  considera- 
tion of  joint  inflammations  which,  for  the  most  part,  are  of 
traumatic  origin.  Unlike  the  human,  the  horse  is  not  subject 
to  many  forms  of  specific  arthritis — tubercular,  gonorrheal,  syph- 
ilitic, etc. 

A  practical  manner  of  classification  of  arthritis  is  traumatic 
and  metastatic. 

Traumatic  arthritis  may  result  from  all  sorts  of  accidents 
wherein  joints  are  contused.  Such  cases  may  be  considered  as 
being  caused  by  direct  injuries.  Instances  of  this  kind,  depend- 
ing on  the  degree  of  insult,  manifest  evidence  of  injury  which 


ETIOLOGY  AND  OCCURRENCE  23 

ranges  from  a  simple  synovitis  to  the  most  active  inflammatory 
involvement  of  the  entire  structure  and  adjacent  tissues. 

The  reactionary  inflammation  wiiich  attends  a  case  of  tarsitis 
caused  b}^  a  horse  being  kieked  is  a  good  example  of  the  i-esult 
of  direct  injury.  Such  cases,  if  the  contusion  is  of  sufficient 
violence,  result  in  arthritis  and  periarthritis.  In  inactive  farm 
horses,  during  cold  weather,  this  condition  l)ecomes  chronic,  swell- 
ing remains  for  weeks  after  all  lameness  and  pain  have  sub- 
sided and  occasionally  hyperthrophy  is  permanent. 

Arthritis  occasioned  by  indirect  injury,  such  as  characterizes 
joint  inflammation  from  continuous  concussion,  is  seen  in  horses 
that  are  worked  at  a  rapid  pace  on  city  streets  or  other  hard 
road  surfaces.  Such  affections  may  be  acute,  as  in  some  cases 
of  spavin,  but  are  usually  inflammatory  conditions  that  do  not 
occasion  serious  disturbance  when  these  affections  become  chronic. 
If  the  involvement  persists  with  sufficient  active  inflammation, 
there  may  follow  erosion  of  cartilage  and  incurable  lameness. 
If  extensive  necrosis  of  cartilage  takes  place,  the  attendant  pain 
will  be  sufficient  to  cause  the  animal  to  favor  the  diseased  part 
and  such  immobilization  enhances  early  ankylosis — nature's  sub- 
stitute for  resolution  in  this  disease. 

Wounds  invading  the  tissues  adjacent  to  joints,  when  these 
wounds  are  of  considerable  extent,  cause  inflammation  of  such 
articulations  by  contiguous  extension  of  inflannnation.  As  long 
as  an  injury  remains  practically  aseptic,  or  if  infected  and  the 
septic  process  does  not  involve  the  joint  proper  by  direct  ex- 
tension, no  more  serious  disturbance  than  a  simple  synovitis  will 
result.  If,  instead,  a  periarthritic  inflammation  is  serious  or 
destructive  in  character,  the  type  of  arthritis  will  be  grave — 
even  though  due  to  an  indirect  cause. 

Where  a  vulnerant  body  penetrates  all  structures  and  invades 
the  interior  of  the  joint  capsule  the  result  is  that  a  more  or  less 
active  disturbance  is  incited.  The  introduction  of  a  sterile  in- 
strument into  a  joint  cavity,  under  strict  asepsis,  where  a  per- 
fect technic  is  executed,  does  not  cause  perceptible  numifesta- 
tion  of  the  injury,  if  the  opening  so  made  is  small — such  as  a 
suitable  exploratory  trocar  makes.  But  a  puncture  made  in  a 
similar  manner  and  with  the  same  instruinciit  witliout  due  regard 


24  LAMENESS  OF  THE  HORSE 

te  asepsis  is  likely  to  cause  an  infectious  synovitis  and  arthritis 
usually  follows. 

A  larger  opening  than  is  produced  by  means  of  an  exploratory 
trochar  may  be  made  into  a  joint  cavity,  causing  escape  of  syn- 
ovia as  it  is  secreted  for  days  and  even  for  weeks  and  no  serious 
or  permanent  trouble  is  experienced  in  some  cases.  If  the  syn- 
ovitis or  arthritis  remains  non-infected  and  the  wound,  trau- 
matic or  surgical,  is  not  too  large,  healing  by  granulation 
occurs,  and  the  discharge  of  synovia  ceases.  However,  if  synovial 
discharge  persists  too  long  because  of  tardy  closure  of  an  open 
joint,  there  is  great  danger  of  infection  gaining  entrance  into 
the  synovial  cavity,  or  in  some  instances,  desiccation  of  endo- 
thelial cells  of  the  articulation  occurs,  in  areas,  and  the  reaction- 
ary inflammation  eventually  results  in  ankylosis. 

A  small  puncture  which  introduces  into  the  synovial  cavity 
infectious  material  of  active  virulence  will  cause  an  arthritis 
that  is  more  serious,  much  more  painful  and  more  difficult  to 
handle  than  is  occasioned  by  a  wound  of  moderate  size,  that 
affords  ready  escape  of  synovia  even  through  the  virulence  of 
the  infection  be  the  same. 

Synovia  is  a  good  culture  medium  and  the  environment  is 
ideal  for  nuiltiplieation  of  bacteria;  consequently,  the  grave 
disturbances  which  may  attend  the  introduction  of  pathogenic 
organisms  into  a  synovial  cavity  as  the  result  of  a  puncture 
Avound  are  not  to  be  forgotten.  The  veterinarian  is  m  no  position 
to  estimate  the  virulency  of  organisms  so  introduced;  neither 
can  he  determine  the  exact  degree  of  resistance  possessed  by  the 
subject  in  any  given  case.  Therefore,  he  is  uncertain  as  to  the 
best  method  of  handling  such  cases  where  an  injury  has  been 
recently  inflicted  and  positive  evidence  of  the  existence  of  an 
infectious  synovitis  is  not  present.  If  one  could  determine  in 
advance  the  degree  of  infection  and  injury  that  is  to  follow  small 
penetrant  M^ounds  of  joint  capsules,  it  would  then  be  possible 
to  select  certain  cases  and  immediately  drain  away  all  synovia 
and  fill  the  cavity  by  injection  with  suitable  antiseptic  solutions. 

This  offers  a  broad  field  for  experimentation  which  will  in 
time  be  productive  of  a  radical  change  in  the  manner  of  treating 
such  cases. 


ETIOLOGY  AND  OCCURRENCE  25 

Metastatic  arthritis  is  seen  more  frequently  in  colts  or  young 
animals  than  in  mature  horses  and  we  here  take  the  liberty  of 
classifying  with  the  arthritis  of  omphalophleliitis  and  strangles 
the  so-called  rheumatic  variety. 

A  specific  polyarthritis  or  synovitis  which  attends  navel  in- 
fection of  foals  is  perhaps  the  most  frequent  form  of  arthritis 
that  is  to  be  considered  metastatic.  This  condition  is  truly  a 
disease  of  young  animals  and,  while  it  is  a  specific  arthritis, 
the  cause  is  yet  to  be  attributed  to  any  definite  pathogenic  organ- 
ism with  certainty.  This  condition  is  well  defined  by  Bollinger 
as  quoted  by  Iloare,^  when  he  calls  it  a  purulent  omphalophle- 
bitis due  to  local  infection  of  the  umbilicus  and  umbilical  ves- 
sels, by  pyogenic  organisms,  causing  a  metastatic  pyemia. 

This  affection  is  grave;  its  course  is  comparatively  brief;  the 
prognosis  is  usually  unfavorable ;  and  omphalophlebitis  occa- 
sions a  form  of  lameness  which  at  once  impresses  the  practi- 
tioner that  serious  constitutional  disturbance  exists.  Its  con- 
sideration properly  belongs  to  discussions  on  practice  or  obstet- 
rics and  diseases  of  the  new  born,  and  it  has  received  careful 
attention  and  is  discussed  at  length  in  these  works. 

A  second  form  of  metastatic  arthritis  is  met  with  in  strangles. 
Strangles  occurs  in  the  young  principally  and  is  not  a  frequent 
cause  of  synovitis  or  arthritis  in  the  adult  animal. 

Strangles  or  distemper  is,  according  to  most  pathologists,  due 
to  the  Streptococcus  equi,  Hoare^  states  that  in  this  type  of 
specific  arthritis  the  contagium  is  probably  carried  by  the  blood. 
He  gives  it  as  his  opinion  that  even  laminitis  has  occurred  as 
a  result  of  the  streptococcus-equi.  This,  indeed,  would  point 
toward  probable  extension  by  the  blood  as  well  as  by  way  of 
lymph  vessels. 

Septic  synovitis  and  infectious  arthritis  are  always  serious  af- 
fections even  in  young  animals  and  much  depends  upon  indi- 
vidual resistance  and  early  rational  treatment  in  such  cases,  if 
recovery  is  to  follow. 

The  same  general  plan  of  treatment  is  indicated  in  this  kind 
of  septic  synovitis  as  is  employed  in  all  cases  of  infective  syn- 


lA  System  of  Veterinary  Medicine  by  E.  Wallis  Hoare,  F.  R.  C.  V.  S.,  Vol.  1, 
page  510. 
=Ibid,  page  807. 


26  LAMENESS  OF  THE  HORSE 

ovitis  and  septie  infection  in  open  joints.  There  is  to  be  consid- 
ered, however,  the  fact  that  the  young  animal  is  more  agile,  a 
better  self-nurse,  and  in  a  general  way  more  apt  to  recover  than 
is  the  adnlt,  under  similar  conditions. 

Rheumatic  artJiritis,  if  one  is  justified  in  classifying  rheumatic 
inflammation  of  joints  as  a  metastatic  form  of  arthritis,  is  not 
a  common  condition,  though  seen  in  mature  and  aged  animals. 
Cases  that  may  be  diagnosed  with  certainty  are  usually  advanced 
affections  wherein  dependable  history  is  obtainable  and  the  symp- 
toms are  well  marked. 

Rheumatism  may  be  thought  of,  with  respect  to  arthritic  in- 
flammation caused  thereby,  as  a  sort  of  pyemia.  Undoubtedly, 
exposure  to  wet  and  cold  weather  is  an  active  factor,  l;)ut  prob- 
ably a  predisposing  one  only.  Likewise  a  member  that  suffers 
from  chronic  inflammation  due  to  recurrent  injury  or  to  con- 
stant or  repeated  strain  is  less  able  to  resist  the  vicissitudes  of 
climate  and  work. 

Consec[uentiy,  rheumatic  arthritis  is  to  be  seen  affecting  horses 
that  are  in  service,  more  often  at  heavy  draft  work  Avhere  they 
are  exposed  to  severe  straining  of  joints;  where  stabling  is  in- 
sanitary; and  where  they  are  obliged  to  lie  down  (if  they  do 
not  remain  standing)  upon  cold  and  wet  ground  or  upon  hard 
unbedded  floors  or  paving. 

Where  such  inhumane  and  cruel  treatment  is  given  animals 
those  responsible  ought  to  be  impressed  with  the  unfairness  to 
the  animal  as  well  as  the  economic  loss  occasioned  by  inflicting 
such  unnecessary  and  merciless  treatment  upon  their  helpless 
and  uncomplaining  subjects.  The  very  nature  of  the  veteri- 
narian's work  affords  liim  constant  and  frequent  opportunity  to 
convince  those  who  are  responsil^le  for  keeping  animals  in  this 
manner,  that  it  is  inhumane  and  un]irofita])]e. 

Cases  of  this  kind  are  not  uncommon  about  some  grading  and 
lumbering  camps  and  in  contract  work  where,  often,  shelter  for 
animals  is  given  little  thought ;  the  result  is  a  cruel  waste  of 
horseflesh. 

Chronic  articular  rheumatism  is  occasionally  observed  in 
young  animals  that  have  never  been  in  service.  In  these  cases 
it  seems   tliat    there   exists   an   individual  susceptibility  and   in 


ETIOLOGY  AND  OCCURRENCE  27 

some  instances  the  condition  is  recurrent.  Each  attack  is  of 
long-er  duration,  and  eventually  death  results  from  continued 
suffering,  emaciation  and  intoxication. 

AFFECTIONS  OF  BURSAE  AND  THECAE. 

Acute  bursitis  and  thecitis  is  of  fre(|uent  occurrence  in  horses 
])ecause  of  direct  injury  from  contusion,  punctures  and  other 
forms  of  traumatism.  These  synovial  membranes,  with  few  ex- 
ceptions, when  inflamed  occasion  a  synovitis  that  may  be  very 
acute,  yet  there  is  less  manifestation  of  pain  than  in  arthritis. 

It  is  only  in  structures  such  as  the  bursa  intertubercularis  or 
in  the  sheath  of  the  deep  digital  flexor  that  an  inflammation 
causes  much  pain  and  is  apt  to  result  in  permanent  lameness. 
This  is  due  to  the  i^eculiar  character  of  the  function  of  such 
structures. 

An  acute  inflammation  of  a  small  bursa  may  even  result  in  the 
destruction  of  such  synovial  apparatus  without  serious  incon- 
venience to  the  subject,  either  at  the  time  of  destruction  or  there- 
after. Obliteration  of  the  superficial  bursa  over  the  summit  of 
the  OS  calcis  is  not  likely  to  cause  serious  inconvenience  or  distress 
to  the  subject  unless  it  be  due  to  an  infected  wound.  Even  then, 
with  reasonably  good  care  given  the  animal,  recovery  is  almost 
certain.  Complete  return  of  function  of  the  member  and  cessa- 
tion of  lameness  takes  place  within  a  few  weeks  in  the  average 
case. 

"Where  an  infectious  synovitis  involves  a  structure  such  as  the 
sheath  of  the  tendon  of  the  deep  digital  flexor  (perforans)  the 
condition  is  grave  and  because  of  the  location  of  this  theca  the 
prognosis  is  not  much  more  favorable  than  in  an  articular  syn- 
ovitis. 

Inflammation  of  bursae  and  thecae  may  be  classified  on  a 
chronological  basis  with  propriety  1)ecause  the  duration  of  such 
affections,  in  many  cases,  materially  modifies  the  result.  A 
chronic  inflammatory  involvement  of  a  theca  through  which  an 
important  tendon  plays  may  cause  adhesions  to  form.  Or  there 
may  occur  erosions  of  the  parts  with  eventual  hypoi-fi-ophy  and 
loss  of  function,  partial  or  complete. 

However,  in  general  practice  a  classiflcation  on  an  etiological 


28  LAMENESS  OF  THE  HORSE 

basis  is  probably  more  practical  and  we  shall  consider  inflamma- 
tion of  bursae  and  thecae  as  infectious  and  noninfectious. 

Infectious  bursitis  and  thecitis  is  usually  the  result  of  direct 
introduction  of  septic  material  into  the  synovial  structure  by 
means  of  injuries.  Infection  by  contiguous  extension  occurs  and 
also  metastatic  involvement  is  met  with  occasionally. 

The  noninfectious  inflammation  of  bursae  and  thecae  usually 
result  from  contusions  or  strains  and  generally  run  their  course 
without  becoming  infective  in  character,  where  vitality  and  re- 
sistance of  the  subject  are  normal. 

In  a  general  way,  inflammation  and  other  affections  of  l)ursae 
and  thecae  are  considered  very  similar  to  like  affections  of  joints. 

AFFECTIONS  OF  MUSCLES  AND  TENDONS, 

Muscles  and  tendons  having  to  do  with  locomotion  are  more 
frequently  injured  than  are  any  of  the  other  structures  whose 
function  is  to  propel  the  body  or  sustain  weight.  This  is  due 
in  part  to  the  exposed  position  of  muscles  and  tendons.  They 
serve  as  a  protection  to  the  underlying  structures  and  in  this 
manner  receive  many  blows  the  force  and  violence  of  which  are 
spent  before  injury  extends  beyond  these  tissues. 

Muscles  of  the  breast,  shoulder  and  rump  are  most  frequently 
the  recipient  of  injuries  of  various  kinds.  The  abductors  of  the 
thigh  are  subjected  to  bruising  when  horses  are  thrown  astride 
of  wagon  poles  or  similar  objects.  Thus  in  one  way  or  another 
muscle  injuries  are  occasioned  and  cause  lameness. 

Traumatic  affection  of  muscles  of  locomotion  may  be  surface 
or  sul)surface — subsurface  with  little  injury  done  the  skin  and 
fascia,  but  with  subsurface  extravasation  of  blood  and  maseera- 
tion  of  tissue.  Puncture  wounds  wherein  the  vulnerant  body  is 
of  small  diameter,  are  observed,  and  they  occasion  deep  seated 
infectious  inflammation  of  the  parts  affected,  with  surface 
wounds  that  are  often  unnotieeable.  Such  injuries — puncture 
wounds — are  always  serious,  and  because  of  the  fact  that  there 
exists  little  evidence  of  injury  at  the  time  of  their  infliction, 
treatment  is  usually  deferred  several  days  and  often  infection 
has  become  quite  extensive  when  the  practitioner  is  consulted. 

"Where  infective  wounds  of  muscles  of  locomotion  occur,  the 


ETIOLOGY  AND  OCCURRENCE  29 

course  and  gravity  of  the  affection  are  directly  influenced  by  the 
proximity  of  the  injury  to  lymph  plexuses.  For  instance,  in- 
juries causing  an  infectious  inflammatory  involvement  of  the  ad- 
ductors of  the  thigh  may  result  in  a  generalization  of  the  infec- 
tion by  way  of  the  inguinal  lymph  glands. 

Large  open  wounds  that  extend  deep  into  muscles,  render 
inactive  such  structures,  and  even  where  division  is  not  com- 
plete, the  pain  occasioned  causes  the  subject  to  favor  the  part 
in  every  way  possible.  Contraction  of  muscular  fibers  of  such 
parts  increases  pain  and  because  of  this  fact  groups  of  muscles 
are  at  times  disabled  because  of  injury  done  to  one  muscle.  In- 
stances of  this  kind  are  frequently  seen  where  shoulder  injuries, 
which  affect  but  one  muscle,  exist;  yet  because  of  such  injury  a 
marked  swinging-leg  lameness  is  present. 

Tendons,  because  of  their  inelasticity,  are  subjected  to  injuries 
peculiar  to  themselves.  In  addition  to  being  affected  as  are  mus- 
cles, wounds  of  many  kinds  are  found  to  affect  tendons — con- 
tusions, interference  wounds,  penetrant  wounds,  incised  wounds 
and  lacerations. 

However,  the  commoner  form  of  injury  done  tendons,  is  strain 
or  sprain.  Because  of  the  sudden  tensile  strain  brought  to  bear 
upon  tendons  in  the  shocks  of  concussion,  as  well  as  in  propulsion 
of  the  body,  there  frequently  occure  a  rupture  of  fibers  and  this 
we  know  as  sprain. 

Sprains  may  be  considered  as  fibrillary  fractures  of  soft  struc- 
tures and  since  this  form  of  injury  is  sul)surface,  and  limited  to 
fractional  portions  of  tendons,  the  inflammation  occasioned  usu- 
ally remains  an  aseptic  one.  Reaction  to  this  form  of  injury 
is  characterized  by  inflammation,  the  course  of  which  is  erratic 
and  variable.  In  chronic  inflammation  of  tendons,  where  ani- 
mals are  continued  in  service,  the  usual  sequel  is  contraction,  or 
shortening  of  these  structures. 

The  degree  of  contraction  as  well  as  its  import  varies  in  dif- 
ferent subjects  and  in  the  various  tendons  which  may  be  affected. 
Contraction  is  a  slow-going  process  that  is  progressive,  gradually 
causing  a  decrease  in  the  length  of  the  affected  structure  and 
eventually    rendering   the    animal    useless. 

The  practice  of  applying  shoes  with  extended  toe-calks  for 


30  LAMENESS  OF  THE  HORSE 

the  purpose  of  "'stretching"  contracted  deep  digital  flexor 
tendons  (tiexor  pedis  perforans)  cannot  be  too  strongly  con- 
demned. While  the  addition  of  an  extension  such  as  is  ordinarily 
employed  to  the  toe  of  a  shoe  of  this  kind,  prevents  for  a  time, 
frequent  stumbling  in  such  cases,  the  increased  tensile  strain 
which  is  thus  occasioned  hastens  further  contraction  and  sub- 
jects animals  so  shod  to  much  unnecessary  pain. 

AFFECTIONS   OF   NERVES. 

Because  of  their  being  protected  by  other  structures,  nerve 
trunks,  which  supply  muscles  of  locomotion,  are  not  su])jeeted  to 
frequent  injuries  such  as  contusions.  However,  they  do  become 
injured  at  times  and  the  result  is  lameness,  more  or  less  severe. 

Lameness  originating  from  nerve  affection,  may  involve  central 
structures  as,  for  example,  the  spinal  cord,  medulla  oblongata 
or  parts  of  the  brain.  In  making  an  examination  of  some  lame 
animals  it  is  necessary  to  distinguish  between  cases  of  lameness 
that  are  of  central  origin  and  marked  by  incoordination  of  move- 
ment, and  disturbances  caused  by  other  affections.  Tetanus  in 
its  incipiency  should  not  be  confused  with  laminitis  involving 
all  four  feet,  or  with  certain  forms  of  pleuritis,  when  careful  ex- 
amination is  made,  yet,  in  a  way,  to  one  not  trained,  the  clinical 
symptoms  are  similar. 

Disturbances  of  nerve  function  are  caused  in  a  variety  of  ways. 
It  is  not  within  the  scope  of  this  work  to  discuss  central  nervous 
disturbances  caused  hy  ingestion  of  mouldy  provender,  or  dis- 
turbances of  the  brain  or  cord  occasioned  by  infectious  diseases, 
but  mention  of  the  existence  of  such  conditions  is  appropriate. 

By  direct  injury  the  result  of  lilows,  certain  nerves  are  in- 
jured and  muscles  supplied  by  such  nerves  are  rendered  inactive. 
Depending  upon  the  nature  and  extent  of  an  injury  thus  in- 
flicted, so  the  manner  in  which  the  affection  is  manifested  varies. 
The  suprascapular  nerve  is  rather  frequently  injured  causing 
partial  or  complete  loss  of  function  of  the  structures  supplied 
by  this  nerve,  and  abduction  of  the  scapulohumeral  joint  nat- 
urally results. 

In  some  cases  of  dystocia  tbe  obturator  ner\'e,  (or  nerves,  if 
the  involvement  is  bilateral),  becomes  injured  by  being  caught 


ETIOLOGY  AND  OCCURRENCE  31 

between  tlie  maternal  pelvis  and  some  dense  part  of  the  fetus. 
This  results  in  paralysis  of  the  adductors  of  the  thigh  if  suffi- 
cient injury  is  done. 

It  is  said  that  nerves  become  over-stretched  and  held  tense,  in 
certain  positions  in  which  animals  are  obliged  to  remain  while 
cast  in  confinement  such  as  in  some  instances  where  unusual 
methods  of  restraint  are  employed.  When  the  fore  feet  are 
drawn  backward  in  such  numner  that  great  strain  is  put  upon 
the  radial  nerve,  it  suffers  more  or  less  injury,  and  this  is  fol- 
lowed by  partial  or  complete  paralysis  which  may  be  temporary 
or  permanent. 

Degenerative  changes  affecting  nerves,  as  in  other  tissues,  oc- 
cur and  more  or  less  locomotory  impediment  will  follow — this 
depending  upon  the  nerve  or  nerves  affected  and  the  nature  of 
such  involvement.  Tumors  may  surround  nerves  and  eventually 
the  nerve  so  exposed  becomes  implicated  in  the  destructive 
process.  Before  degenerative  changes  take  place  in  the  nerve 
substance,  in  such  cases,  pressure  may  completely  paralyze  a 
nerve  when  it  is  so  situated.  Melanotic  tumors  in  the  para- 
proctal  tissue  in  some  cases,  because  of  the  large  size  of  the  new- 
growths,  cause  paralysis  of  the  sciatic  nerve.  The  author  has  seen 
one  case  of  brachial  paralysis  occasioned  by  an  enormous  de- 
veloiunent  of  fibrous  tissue  involving  the  structures  about  the 

ulna. 

AFFECTIONS  OF  BLOOD  VESSELS. 

Lameness  caused  by  disturbances  of  circulation  may  be  due  to 
structural  affection  of  vessels,  or  functional  disorders  of  the 
heart,  and  in  some  instances,  a  combination  of  these  causes  may 
be  active. 

Direct  involvement  of  vessels  is  the  commoner  form  of  circu- 
latory disturbance  which  occasions  lameness,  and  the  most  fre- 
quent cause  is  of  parasitic  origin.  Sclerostomiasis  with  attendant 
arteritis,  thrombus  formation  and  su])sequent  lodgement  of  em- 
boli in  the  iliac,  femoral,  or  other  arteries,  causes  sufficient  ob- 
struction to  prevent  free  circulation  of  blood,  and  the  character- 
istic lameness  of  thrombosis  results. 

Indirect  injury  to  vessels  may  occur  because  of  contused 
wounds  and  subsequent  inflammation  of  tissues  supplied  by  such 


32  LAMENESS  OF  THE  HORSE 

vessels.  If  the  injury  be  of  sufficient  extent,  considerable  ex- 
travasation of  blood  will  take  place  and  the  painfully  swollen 
parts  necessarily  impair  locomotion.  In  such  instances  lymph 
vessels  participate  in  the  disturbance,  and  the  condition  then  be- 
comes one  wherein  lymphangitis  is  the  predominant  disturbing 
element. 

Angiomatous  tumors  are  occasionally  found  affecting  horses' 
legs — usually  the  result  of  some  injury ;  and  because  of  their  size 
or  position,  they  mechanically  interfere  with  function.  Further- 
more, when  such  tumors  are  located  on  the  inner  or  flexor  side 
of  joints,  enough  pain  is  occasioned  that  affected  animals  show 
evidence  of  distress,  usually  by  intermittent  lameness. 

Horses  do  not  suffer  from  distension  of  veins  as  does  man, 
that  is,  there  is  rarely  to  be  seen  a  case  wherein  much  disturbance 
from  this  source  exists. 

AFFECTIONS  OF  LYMPH  VESSELS  AND  GLANDS. 

Inflamed  lymph  vessels  and  glands,  the  result  of  various  causes, 
is  a  rather  common  source  of  lameness  of  horses.  When  one  con- 
siders the  proportion  of  tissue  that  is  composed  of  lymph  vessels 
and  glands,  it  is  then  obvious  that  inflammation  of  these  struc- 
tures should  cause  a  painful  affection  of  members,  when  so  af 
fected,  and  that  marked  lameness  and,  in  some  instances,  general 
constitutional  disturbance  such  as  anorexia,  hyperthermia  and 
general  circulatory  disorder  are  to  follow. 

Lymphangitis  is  most  frequently  occasioned  by  the  introduc- 
tion of  septic  material  into  the  tissues;  consequently,  infectious 
lymphangitis  is  more  frequently  observed  than  the  non-infectious 
type. 

Specific  infectious  forms  of  lymphangitis  are  seen  in  glanders 
and  in  strangles ;  infectious  types  of  this  disturbance  are  found 
in  many  instances  where,  initially,  a  localized  or  circumscribed 
infection  has  occurred — the  contagium  having  been  introduced 
by  way  of  an  injury.  An  example  of  this  kind  is  to  be  seen  in  a 
wound  perforating  the  tibial  fascia,  where  the  injury  is  inflicted 
by  means  of  a  horse  being  kicked  by  another  animal  shod  with 
sharp  shoe-calks.  Cases  of  this  kind  invariably  result  in  a  septic 
lymphangitis,  and  frequently  lymphadenitis  also  occurs,  for  the 


ETIOLOGY  AND  OCCURRENCE  33 

inguinal  lymph  glands  are  so  situated  tliat  their  becoming  con- 
taminated is  almost  certain. 

The  trite  phrase  that ' '  the  tissues  are  bathed  in  lymph ' '  should 
make  clear  the  reason  for  the  frequent  occurrence  of  infectious 
lymphangitis  and  lymphadenitis.  Foreign  substances,  bacteria 
and  their  products,  inorganic  material  and  in  fact,  anything  that 
is  inti-oduced  into  the  tissues,  if  soluble  or  miscible,  will  be  taken 
up  and  conveyed  by  the  afferent  lymph  vessels  and  disseminated 
throughout  the  system — hence  the  constitutional  disturbances  so 
frequently  thus  caused. 

A  non-infectious  type  of  lymphangitis  is  frequently  seen  in 
the  heavy  draft  breeds  of  horses  and  in  such  cases  one  or  both 
hind  legs  are  involved — it  is  very  seldom  that  the  thoracic  limbs 
become  so  affected.  Law^  refers  to  this  ailment  as  "Acute 
Lymphangitis  of  Plethora  in  Horse."  When  one  takes  into 
consideration  that  these  cases  so  frequently  occur  in  heavy  draft 
animals  that  are  not  worked  regularly,  that  the  pelvic  limbs  are 
the  ones  involved,  and  that  the  disorder  often  runs  a  short 
course  (recover}'  often  taking  place  within  two  or  three  days, 
with  no  treatment  given  other  than  a  purge,  circulatory  stim- 
ulants and  walking  exercise)  it  is  plausible  to  ascribe  the  con- 
dition to  idiopathic  factors. 

Admitting  the  frequency  of  non-infectious  lymphangitis,  the 
practitioner  must  not  confuse  this  type  with  similar  lymphatic 
inflammation  occasioned  by  nail  punctures  of  the  foot.  It  is 
very  embarrassing  indeed  to  make  a  diagnosis  of  lymphangitis — 
expecting  that  the  disturbance  will  terminate  favorably  and  un- 
eventually — and  later  to  discover  a  sub-solar  abscess  caused  by 
a  nail  prick  in  the  region  of  the  heel. 

Recurrent  attacks  of  this  disturbance  cause  hypertrophy  of 
the  lymph  vessels  and  in  some  cases  lymphangiectasis.  In  old 
subjects  used  for  dissection  or  surgical  purposes,  it  is  very  evi- 
dent that  in  the  ones  which  have  suffered  from  chronic  lymphan- 
gitis there  exists  an  excessive  amount  of  sub-facial  connective 
tissue,  making  subcutaneous  neurectomies  quite  difficult  in  some 
instances. 

A  sequel  of  chronic  lymphangitis  is  a  condition  known  as  ele- 


'A'ol.    I,    page    534,   Veterinary   Medicine,   by  James   Law,    F.    R.    C.    V.    S. 


34  LAMENESS  OF  THE  HORSE 

pliantiasis.  In  such  cases  there  occurs  a  hyperplasia  of  the  skin 
and  subcutaneous  tissues,  resulting  in  some  instances,  in  the  af- 
fected member  attaining  an  enormous  size.  Sporadic  cases  of 
this  kind  are  to  be  seen  occasionally,  and  are  apparently  caused 
by  repeated  attacks  of  lymphangitis.  The  affection  is  not  bene- 
fited by  treatment,  and  while  a  horse's  leg  may  become  so  heavy 
and  cuniliersome  as  to  mechanically  impede  its  gait,  as  well  as 
to  fatigue  the  subject  when  made  to  do  service  even  at  a  slow 
pace,  elephantiasis  causes  no  constitutional  derangement.  The 
hind  legs,  in  elephantiasis,  are  affected  and  a  unilateral  involve- 
ment is  more  often  seen  than  a  bilateral  one.  The  legs  may  be 
enlarged  from  the  extremity  to  the  body,  but  ordinarily  the  af- 
fection does  not  extend  higher  than  the  hock  or  the  mid-tibial 
region. 

A  chronic,  progressive,  hyperplastic-degeneration  exists  in 
some  cases  and  the  sul)jects  are  in  time  rendered  unserviceable 
because  of  the  l)urden  of  getting  about  encumbered  by  the  affected 
extremity.  In  other  animals  hyperplasia  progresses  for  a  time 
— until  the  parts  become  greatly  enlarged  and  conditions  appar- 
ently attain  an  immutable  state.  Nevertheless  animals  so  af- 
fected may  continue  in  service  for  years  without  lieing  distressed. 

AFFECTIONS   OF   THE   FEET. 

Lameness  is  very  often  due  to  affections  of  the  feet,  and  in  all 
foot  diseases  probably  the  most  constant  cause  is  injury  inflicted 
in  some  manner.  Resultant  from  injury,  there  frequently  de- 
velops complications  and  the  one  most  often  seen  is  infection. 

Because  of  the  fact  that  the  feet  are  constantly  exposed  to 
germ-laden  soil  and  filth,  if  not  actually  bathed  in  such  infectious 
materials,  it  naturally  follows  that  septic  infection  of  some  part 
of  the  feet  must  be  of  frequent  occurrence. 

Subsequent  to  being  obliged  to  stand  in  mud  and  other  damp 
or  wet  media,  exposure  to  desiccating  influences  such  as  stabling 
U])()n  dry  floors,  or  at  service  on  hot  and  dry  road  surfaces  causes 
the  insensitive  pai'ts  of  tlie  feet  to  become  dry,  hard  and  brittle. 
This  favors  ''checking"  of  the  protecting  structures  and  it  fre- 
(picntly  i-esults  in  the  roi'iiiatioii  of  large  fissures  which  expose 


ETIOLOGY  AND  OCCURRENCE  35 

the  underlying  sensitive  parts  of  the  feet  and  lameness  is  the  in- 
evita])le  outcome. 

The  function  of  the  feet — bearing  the  weight  of  the  animal  at 
all  times  when  the  subject  is  not  recumbent,  and  in  addition  to 
this,  the  increased  strain  put  upon  them  at  heavy  draft  work, 
together  ^^  ith  the  concussion  and  l)uffeting  occasioned  by  locomo- 
tion, make  the  feet  susceptible  to  frequent  affections  of  various 
kinds. 

Being  almost  completely  encased  by  a  somewhat  inexpansible 
and  insensitive  wall  and  sole,  renders  the  foot  subject  to  path- 
ologic changes  peculiar  to  itself.  The  very  nature  of  the  struc- 
ture of  the  foot  together  with  the  function  of  the  sensitive  lamina 
is  sufficient  cause  for  an  affection  unlike  that  seen  involving  other 
tissues — laminitis. 

An  exhaustive  consideration  of  foot  affections  is  a  study  in 
itself  and  one  that  comes  within  the  realm  of  pathologic  shoeing; 
nevertheless,  a  practical  knowledge  of  diseases  of  the  foot  is 
indispensable  in  the  diagnosis  of  lameness  wherein  the  foot  may 
be  at  fault. 

The  peculiar  nature  of  foot  affections  renders  them  difficult 
of  classification  on  any  sort  of  basis  that  is  helpful  in  the  con- 
sideration of  this  subject.  Injuries  are  the  most  constant  cause 
of  foot  lameness,  yet  one  must  admit  that  there  results  compli- 
cations because  of  infection  in  most  instances ;  and  that  in  some 
cases  the  injury  is  slight — just  enough  to  permit  the  introduction 
of  vulnerant  organisms  into  the  tissues.  Therefore,  one  might 
well  classify  affections  of  the  feet  as  infectious  and  non- 
infectious. There  can  be  grouped  in  the  class  of  infectious  af- 
fections such  conditions  as  nail  pricks,  calk  wounds  and  canker. 
In  the  class  of  non-infectious  affections  one  may  consider  condi- 
tions such  as  laminitis.  strain  and  fractures. 


SECTION  II. 
DIAGNOSTIC  PRINCIPLES. 

To  observe  attentively  is  to  remember  distinctly. — Poe. 

Before  treatment  is  administered  in  constitutional  disturb- 
ances resulting  in  disease,  cause  is  logically  sought;  so,  in 
order  to  handle  effectively  any  case  of  lameness,  it  is  necessary 
first  to  discover  the  source  of  the  trouble  and  contributing  con- 
ditions affecting  the  structures.  Hence,  diagnostic  ability  is 
the  prime  requisite;  and  a  thorough  knowledge  of  pathologic 
anatomy  or  of  surgical  technic  is  of  little  value  if  this  knowledge 
is  not  applied  with  the  insight  of  the  trained  diagnostician. 

The  cruel  and  unnecessary  methods  employed  by  those  un- 
trained for  diagnostics,  cannot  be  too  vigorously  condemned.  For 
instance,  the  application  of  an  active  and  depilating  vesicant 
upon  a  large  area  on  the  gluteal  or  crural  region,  in  a  case 
where  the  practitioner  "guesses"  the  condition  to  be  one  of 
"hip  lameness,"  constitutes  an  exposition  of  gross  ignorance, 
and  at  once  stamps  the  perpetrator  as  a  crude  bungler  without 
scientific  insight  whose  works  are  no  credit  to  his  profession. 
How  much  better  it  would  be,  if  the  practitioner  does  not  see 
fit  to  call  in  a  competent  consultant,  to  prescribe  a  suitable  agent 
to  be  given  internally,  and  to  recommend  complete  rest  for  the 
subject. 

In  establishing  a  diagnosis  in  such  cases,  the  student  or  prac- 
titioner seldom  has  recourse  to  laboratory  assistance,  and  his 
work  is  done  by  means  of  physical  examination ;  therefore,  a 
thorough  knowledge  and  a  clear  conception  of  the  physiology 
of  locomotion  are  essential.  Memorizing  nosological  facts  with- 
out an  understanding  of  underlying  principles  is  of  no  more 
practical  benefit  for  qualification  as  a  diagnostician  in  cases  of 
lameness,  than  is  the  employment  of  similar  methods  in  the 
study  of  theory  and  practice.  A  knowledge  of  the  dosage  of 
drugs  does  not  in  itself  qualify  one  as  being  competent  to  ad- 
minister  such   therapeutic    agents   to    a   proper    effect.      How 

S7 


38  LAMENESS  OF  THE  HORSE 

much  is  a  practitioner  benefited  by  the  knowledge  that  a  high 
temperature  is  usually  present  in  septic  intoxication,  if  he  is 
not  possessed  of  a  scientific  understanding  of  anatomy,  physi- 
olog}',  bacteriology  and  pathology,  as  well  as  the  principles  of 
clinical  diagnosis? 

In  order  to  determine  the  reasons  for  certain  symptoms  mani- 
fested by  the  suliject,  an  analysis  of  these  symptoms  is  the  proper 
method  of  procedure,  insofar  as  this  is  poasi])le.  If  one  may 
reason  that  an  animal  assumes  a  certain  position  while  at  rest 
to  allow  relaxation  of  an  inflamed  tendon  or  ligament,  such  a 
fact  enables  the  diagnostician  to  recall  that  this  is  indicative 
of  some  specific  ailment.  In  acute  tendinitis,  the  subject  while 
at  rest,  maintains  the  afi'ected  member  in  volar  flexion  because 
this  position  permits  relaxation  of  the  inhibitory  apparatus, 
including  the  inflamed  tendon.  Likewise,  the  various  a])normal 
positions  assumed, — adduction,  abduction,  undue  flexion  or 
pointing — have  their  own  significance  and  are  taken  into  ac- 
count by  the  trained  diagnostician  in  the  course  of  an  examina- 
tion. 

In  the  examination  of  lame  subjects,  where  the  cause  is  noi 
obvious,  a  systematic  method  of  diagnosis  is  pursued  even  by 
the  most  expert  practitioners.  In  all  obscure  cases  of  lameness 
a  methodical  and  thoroughly  practical  examination  of  the  ani- 
mal according  to  an  established  procedure  is  necessary  to  de- 
termine the  nature  and  source  of  the  affliction. 

Anamnesis. 

The  first  thing  to  be  given  consideration  in  diagnosis  is  the 
fact  that  related  history  of  the  case  is  not  always  dependable, 
because  of  lack  of  accurate  observation  (u^  wilful  deceit  on  the 
])art  of  the  owner  or  attendant.  The  successful  veterinarian 
soon  acquires  the  faculty  of  ol)taining  information  in  a  manner 
best  adapted  to  his  client,— either  by  direct  interrogation  or  by 
subtle  means  of  suggestion,  and  in  this  way  he  draws  out  evaded 
facts  essential  to  his  diagnosis.  In  time  he  learns  to  make  al- 
lowance for  misstatements  made  to  shield  the  owner  or  driver 
and  to  hide  the  facts  of  apparent  neglect  or  abuse  that  the  sub- 
ject may  have  experienced.    A  suppurating  cartilaginous  quitter, 


DIAGNOSTIC    PRINCIPLES  39 

complicated  by  the  presence  of  a  large  amount  of  hyperplastic 
tissue,  cannot  be  successfully  represented  to  be  an  acute  and 
recently  developed  atfection,  where  a  trained  practitioner  is  left 
to  judge  the  validity  of  the  statement. 

In  complicated  conditions,  where  there  is  evident  a  chronic 
disturbance  which  could  not  be  conceived  as  sufficient  cause  for 
a  nuirked  manifestation  of  lameness,  accurate  history  of  the  case 
may  he  of  great  aid  in  arriving  at  a  diagnosis.  An  aged  animal, 
having  recently  become  very  lame,  showing  a  small  exostosis  on 
the  first  phalanx,  and  with  the  history  given  that  the  osseous 
deposit  was  of  long  standing,  should  at  once  lead  the  veterinarian 
to  seek  the  source  of  trouble  elsewhere. 

Visual  Examination. 

As  in  all  diagnostic  work,  a  careful  visual  examination  of  the 
subject  should  ])e  made  before  it  is  approached.  The  novice  is 
given  to  hasty  examination  by  palpation,  not  realizing  how 
nnieh  may  be  revealed  by  a  careful  scrutiny  of  the  subject.  In 
this  way  he  is  led  to  erroneous  conclusions  which  the  skilled 
diagnostician  has  learned  from  experience  to  avoid.  Too  much 
(iitphasis  cannot  he  2)laccd  on  the  importance  of  making  a 
thoughtful  visual  examination  in  every  instance  before  the  sub- 
ject is  approached.  In  this  examination,  type,  conformation 
and  temperament  are  taken  into  account  at  once,  for  each  of 
these  qualities  is  in  itself,  a  determining  factor  in  predisposing 
a  subject  to  certain  ailments  or  inherent  attributes,  which  may 
exert  a  favorable  or  unfavorable  intiuenee  upon  existing  condi- 
tions and  thus  make  recovery  probable  or  otherwise. 

Draft  animals  are  less  likely  to  be  permanently  incapacitated 
as  a  result  of  tendinitis,  than  are  thoroughbreds.  Likewise, 
one  would  not  expect  to  find  this  affection  present  in  heavy 
harness  horses  as  frequently  as  in  light  harness  animals. 

]\ral-formation  of  a  part,  or  an  asymmetrical  development  of 
the  body  as  a  whole,  may  render  an  animal  susceptible  to  cer- 
tain affections  which  cause  lameness.  A  "tied  in"  hock  predis- 
poses the  subject  to  curb,  and  an  animal  having  powerful  and 
well-developed  hips  and  imperfectly  formed  hocks,  will,  if  sub- 
jected to  heavy  work,  be  a  favorable  subject  for  bone  spavin. 


40  LAMENESS  OF  THE  HORSE 

The  matter  of  temperament  cannot  be  disregarded  in  diag- 
nosis, for  in  some  instances,  it  is  the  chief  determining  factor 
which  materially  influences  the  outcome  of  the  case.  A  nervous, 
excitable  animal,  that  is  kept  at  hard  work,  may,  under  some 
conditions,  be  expected  to  experience  disturbances  which  more 
lethargic  subjects  escape.  Nervous  subjects,  it  is  known,  are 
more  prone  to  azoturia  than  are  those  of  lymphatic  temperament. 
Furthermore,  the  lymphatic  subject  often  recovers  from  cer- 
tain bone  fractures  which  are  successfully  treated  only  when 
the  animal  is  sufficiently  resigned  by  nature  to  remain  confined 
in  a  sling  for  weeks  without  resistance. 

The  physiognomy  of  a  subject  is  often  indicative  of  the  gravity 
of  its  condition.  The  facial  expression  of  an  animal  suffering 
the  throes  of  tetanus,  azoturia,  or  acute  synovitis,  is  readily 
recognized  by  the  experienced  eye,  and  upon  physiognomy  alone, 
in  many  instances,  may  the  opinions  regarding  prognosis  be 
based.  Particularly  is  this  true  where  death  is  a  matter  of  min- 
utes, or  at  most  is  only  a  few  hours  distant. 

Due  allowance  should  be  made  for  restiveness  nmnifested  by 
some  more  nervous  animals  when  the  surroundings  are  strange 
and  unusual.  In  such  instances,  even  pathognomic  symptoms 
may  be  masked  to  the  extent  that  little,  if  any,  sign  of  pain 
or  malaise  is  evinced.  In  these  cases  the  subject  should  be 
given  sufficient  time  to  adjust  itself  to  the  new  environment,  or 
it  should  be  removed  to  a  more  suitable  place  for  examination. 
Animals  quickly  detect  the  note  of  friendly  reassurance  in  the 
human  voice  and  can  very  often  be  calmed  by  being  spoken  to. 

By  visual  examination  one  may  detect  the  presence  of  various 
swellings  or  enlargements,  such  as  characterize  bruises  and 
strains  of  tendons  where  inflammation  is  acute.  Inflammation 
of  the  plantar  (calcaneocuboid)  ligament  in  curb  is  readily  de- 
tected when  the  affected  member  is  viewed  in  profile.  Spavin, 
ringbone,  splints,  quittor  and  many  other  anomalous  conditions 
may  all  be  observed  from  certain  proper  angles. 

The  fact  that  the  skins  of  most  animals  are  pigmented  and 
covered  with  hair,  precludes  the  easy  detection  of  erythema  by 
visual  examination,  consequently  this  indicator  of  possible  in- 


DIAGNOSTIC    PRINCIPLES  41 

fiammation   is   not   often   made   use   of   in    the   examination   of 
equine  subjects. 

Attitude  of  the  Subject. 

The  position  assumed  while  the  subject  is  in  repose,  is  often 
characteristic  of  certain  affections  and  this,  of  course,  is  noted 
at  once.  The  manner  in  which  the  weight  is  borne  by  the  animal 
at  rest,  should  attract  the  attention  of  the  diagnostician  and  if 
the  attitude  of  the  subject  is  abnormal  or  peculiar,  the  ex- 
aminer tries  to  determine  the  reason  for  it.  If  weight-bearing 
causes  symptoms  of  pain,  the  affected  member  will  invariably  be 
favored  and  held  in  some  one  of  a  number  of  positions.  The 
foot  may  contact  the  ground  squarely  and  yet  the  leg  may  re- 
main relaxed  and  free  from  pressure;  volar  flexion,  in  such 
cases,  is  indicative  of  inflammation  of  a  part  of  the  flexor  ap- 
paratus. If  the  condition  be  very  painful,  position  of  the  af- 
flicted member  is  frequently  shifted,  but  in  all  cases  where  the 
pain  is  not  so  keenly  felt,  the  inflamed  member  is  held  in  a 
state  of  relaxation.  There  is  need  then,  for  a  knowledge  of 
anatomy  and  certain  principles  in  physics  to  enalile  tlie  ol)server 
to  determine  just  which  structures  are  purposely  eased  in  this 
manner.  Where  palpation  of  parts  is  possible,  one  does  not 
need  to  depend  on  visual  examination  alone,  and  it  is  always 
wise  to  take  into  consideration  every  factor  that  may  influence 
conditions.  Manipulation  or  palpation  of  the  stnictures  thought 
to  be  involved,  should  not  he  resorted  to  until  a  careful  and 
thorough  observation  of  the  subject  has  revealed  all  that  it  can 
reveal  to  the  diagnostician. 

In  all  conditions  where  extreme  pain  is  manifested  by  the 
constant  desire  of  the  animal  to  keep  its  foot  in  motion  off 
the  ground,  examination  should  be  made  for  local  cause.  This 
is  seen  in  certain  septic  inflammations  of  the  feet  such  as  those 
caused  by  nail  punctures  invading  the  navicular  joint,  or  in 
newly  made  wounds  where  nerves  have  been  divided  and  the 
proximal  end  of  such  a  nerve  is  exposed  to  pressure  or  irritation. 

"Pointing"  affords  a  comfortable  position  in  some  cases  of 
navicular  disease,  and  in  a  unilateral  affection,  one  may  observe 
the  subject  bearing  weight  with  one  sound  member,  while  the 
affected  foot  is  planted  well  ahead  of  the  sound  one.     In  a  bi- 


42  LAMENESS  OF  THE  HORSE 

lateral  involvement  of  this  kind,  weight  may  be  frequently 
shifted  from  one  foot  to  the  other,  or  in  chronic  cases,  where 
no  marked  pain  is  experienced,  the  subject  stands  squarely  upon 
both  front  feet  and  no  peculiar  shifting  of  weiglit  or  pointing  is 
evident. 

In  some  cases  of  hip  or  shoulder  involvement,  complete  re- 
laxation of  all  parts  of  the  affected  member  may  be  noticed. 
In  brachial  paralysis,  the  pectoral  member  is  held  limply;  if  the 
patient  is  made  to  move,  it  is  evident  there  is  lack  of  innerva- 
tion to  the  afflicted  part.  In  some  cases  where  contusion  has 
caused  acute  inflammation  of  the  member,  the  subject  instinct- 
ively tries  to  keep  it  inactive  to  relieve  the  pain  which  move- 
ment occasions. 

Where  there  is  an  active  and  painful  inflammation  of  the 
prescapular  lymph  glands  and  contiguous  structures,  in  some 
cases  of  ''levator-humeri  abscess,"  the  scapulohumeral  joint  is 
extended.  This  is  brought  about  by  flexion  of  the  elbow  and 
carpal  joints. 

There  are  some  eases  of  bi-lateral  affections  which  occasion 
such  pain  during  weight-bearing  that  the  subject  shifts  its 
weight  from  one  affected  leg  to  the  other;  an  example  of  this 
condition  may  be  observed  in  any  acute  case  of  gonitis  which 
affects  both  patellar  regions,  making  it  ecjually  painful  to  bear 
the  weight  on  either  member. 

A  peculiar  characteristic  position  is  assumed  in  acute  laminitis 
of  the  fore  feet.  In  such  instances,  the  hind  feet  are  brought 
forward  under  the  body  sufficiently  to  relieve  the  front  feet  of 
the  weight,  insofar  as  is  possible  by  the  abnormal  position  taken 
in  cases  of  acute  laminitis. 

So  in  each  position  that  is  abnormal  to  any  degree,  assumed 
by  a  suffering  animal,  there  may  l^e  deduced,  the  fact  that  the 
subject  is  attempting  to  relieve  the  affected  structures,  and  in 
each  clinical  picture  of  this  kind,  the  trained  diagnostician  sees 
some  index  to  the  nature  and  source  of  the  trouble.  Further 
examination  is  rendered  more  effective  because  of  this  prelim- 
inary visual  examination  which  has  precluded  the  unnecessary 
annoyance  of  the  animal  by  manii)nlating  unaffected  structures. 

It  has  been  presupposed  in  the  foregoing,  that  the  one  raak- 


DIAGNOSTIC    PRINCIPLES  4'd 

iiig  visual  examination  of  a  lame  animal  for  diagnostic  purposes, 
will  remcml)er  that  vritli  the  normal  animal  the  -weight  is  borne 
equally  well  with  both  fore  legs;  and  that  this  is  done  without 
shifting  from  one  to  the  other;  and  that  the  pelvic  limbs  do  not 
support  the  body  in  this  manner.  Normal  su])jects  shift  their 
weight  from  one  hind  leg  to  the  other  and  the  one  relaxed,  rests 
in  a  state  of  tiexion  with  the  toe  on  the  ground  and  the  heel 
raised. 

Examination  by  Palpation. 

In  nearly  every  case  where  lameness  exists  an  examination  of 
the  affected  parts,  by  palpation  or  by  digital  manipulation, 
is  necessary  before  an  accurate  conclusion  may  be  drawn ;  but 
in  making  this  kind  of  an  examination  one  needs  to  exercise  good 
judgment  lest  he  fail  to  acquire  a  correct  impression  of  the 
actual  existent  conditions.  There  is  need  for  the  diagnostician, 
here,  as  well  as  in  other  conditions  where  physical  examination 
is  made,  to  api)roach  the  subject  in  a  manner  that  will  not  ex- 
cite or  disturb  to  the  extent  that  the  animal  will,  in  one  way 
or  another,  resist  or  object  to  the  approach  of  the  diagnostician, 
thereby  masking  the  symptoms  sought.  The  practitioner  would 
best  acquire  skill  as  a  horseman — if  he  is  not  possessed  of  such 
— and  handle  each  individual  subject  in  the  manner  calculated 
to  best  suit  the  temperament  of  the  animal  examined.  The 
unbroken  subject  is  not  handled  as  satisfactorily  as  is  the  in- 
telligent family  horse ;  in  the  former,  in  some  cases,  little  de- 
pendence is  placed  upon  digital  examination. 

By  palpation  one  is  enabled  to  recognize  hyperthermia  and 
this,  in  lieu  of  dependable  history,  is  at  times  sufficient  evidence 
upon  which  to  determine  the  duration  of  any  given  inflammatory 
affection. 

By  comparison  of  different  parts  of  the  same  member  or  with 
an  analogous  portion  of  another  member  any  marked  increase  in 
the  apparently  normal  temperature  of  a  part  at  once  signalizes 
inflammation.  In  this  manner,  in  examining  a  case  where 
laminitis  or  other  inflammation  of  the  feet  is  suspected,  one  may 
arrive  at  a  fairly  accurate  conclusion  without  the  employment 
of  other  means.  Throbbing  vessels  are  not  always  easily  rec- 
ognized if  the  subject  is  a  victim  of  chronic  lymphangitis. 


44  LAMENESS  OF  THE  HORSE 

In  some  instances,  where  a  moderate  degree  of  lameness  exists 
and  cause  is  apparently  obscure,  the  recognition  of  hyperthermia 
may  be  the  deciding  factor  in  establishing  a  diagnosis.  In  cases 
of  sprained  ligaments  in  the  phalangeal  region,  because  of  the 
dense  character  of  the  structures  involved,  little  if  any  evidence 
of  the  cause  of  lameness,  other  than  local  heat,  may  be  found 
twenty-four  hours  after  the  injury  has  been  inflicted. 

In  order  to  determine  the  amount  or  extent  of  hyperthermia 
with  a  fair  degree  of  accuracy  in  any  given  case,  one  must  make 
due  allowance  for  external  conditions  affecting  temperature ; 
also  the  effect  of  a  considerable  amount  of  hair  covering  an  area, 
as  well  as  any  possible  dirt  contacting  the  surface  of  the  skin 
must  be  taken  into  account.  All  dirt  should  be  removed  if  prac- 
ticable, so  that  the  diagnostician's  palms  may  come  as  nearly 
in  contact  with  the  inflamed  structures  as  possible.  Then,  too, 
the  sense  of  touch  if  the  operator's  hands  are  chilled,  is  not  de- 
pendable. In  such  instances  the  novice  wnll  need  to  be  de- 
liberate as  to  his  findings — whether  or  not  hyperthermia  really 
exists.  Such  an  examination  is  of  little  value  where  the  sub- 
ject's feet  are  wet  and  an  examination  is  hurriedly  made,  as  in 
eases  of  suspected  laminitis. 

Often,  before  being  able  to  di.stinguish  the  presence  of  a 
hyperthermic  condition,  one  is  impressed  with  the  fact  that  an 
animal  manifests  evidence  of  being  supersensitive.  In  fact, 
some  animals  in  the  anticipation  of  pain  at  the  touch  of  an  in- 
jured part,  will  instinctively  withdraw — in  self-protection — such 
an  ailing  member  or  resist  the  approach  of  the  practitioner.  This 
sensitiveness  is  more  apparent  in  animals  that  have  been  sub- 
jected to  previous  manipulation  or  treatment  which  has  oc- 
casioned pain,  and  consequently,  allowance  must  be  made  for 
this  exhibition  of  fear.  No  better  example  of  this  condition  can 
be  imagined  than  is  present  in  cases  of  "shoe  boil."  where 
there  exists  an  extensive  area  of  acute  inflammation  of  the  el- 
bow. There  is  always  more  or  less  surface  disturbance  wherever 
vesication  has  ])een  produced,  and  in  cases  where  irritants  of 
any  kind  have  been  employed  for  several  days  or  a  week  previous 
to  an  examination,  more  or  less  supersensitiveness  is  to  be  ex- 
pected. 


DIAGNOSTIC    PRINCIPLES  45 

One  must  not  lose  sight  of  the  fact  that  unscrupulous  dealers, 
— "traders" — make  use  of  their  knowk^dge  of  this  principle  in 
various  way  usually  for  the  purpose  of  attracting  attention  to 
a  part,  which,  presumably  might  have  been  blistei'ed  in  order  to 
intentionally  produce  inflammation  of  tissu'^s.  iti  this  way; 
causing  lameness  which  is  not  manifested  until  an  animal  has 
been  kept  by  its  new  owner  for  twenty-f(  U)-  Ik  urs  or  more. 
This,  to  be  sure,  usually  makes  a  dissatisfied  purchaser  who  is 
willing  to  dispose  of  his  newly  acquired  animal  at  a  sacrifice. 
thus  enabling  the  original  owner  or  his  agent  to  regain  posses- 
sion of  the  victimized  animal  at  less  than  its  real  value. 

Some  nervous  animals,  because  of  the  manner  of  approach  of 
the  practitioner,  are  wont  to  flinch,  and  there  is  manifested  a 
pseudo-supersensitiveness.  Young  animals  not  accustomed  to  be- 
ing handled  are  likely  to  be  timorous,  and  one  must  not  hastily 
conclude  that  a  part  is  painful  to  the  touch  because  the  subject 
resents  even  gentle  digital  manipulation  of  such  parts.  In 
instances  of  this  kind,  one  needs  to  compare  sensibility  by  manip- 
ulation of  different  parts  of  the  subject's  liody  in  a  careful  and 
gentle  manner ;  and  by  exercising  patience  and  good  judgment 
in  such  work,  it  is  possible  to  actually  distinguish  between  nor- 
mal sensibility  and  abnormal  sensitiveness,  in  most  cases.  Here, 
again,  the  diagnostician  needs  to  jiossess  skill  as  a  horseman  and 
good  judgment  as  to  individual  temperament  of  different  animals, 
under  any  condition  which  may  exist  af  the  time  he  makes  his 
examination. 

By  palpation  alone,  one  can  recognize  the  presence  of  fluctu- 
ating enlargements ;  one  may  not  oidy  recognize  such  conditions, 
but  distinguish  between  a  fluctuating  ma-s  such  as  exists  in  non- 
strangulated  hernia  and  a  large  fibrous  tumor.  By  palpation, 
for  the  recognition  of  density  and  for  determining  the  presence 
or  absence  of  hyperthermia,  one  may  decide  that  there  exists 
an  abscess  and  not  a  tumor.  Edematous  swellings  are  recog- 
nized by  palpation, — the  characteristic  indentations  which  may 
be  made  in  dropsical  swellings  are  pathognomonic  indicafoi-s. 
In  this  manner  it  is  easy  to  differentiate  post-operative  or  i)cst- 
traumatic  edemas  which  may  or  may  not  cause  lameness.  At 
any  rate,  it  is  essential  to  take  into  account  all  determinate  con- 


46  LAMENESS  OF  THE  HORSE 

ditions  that  may  assist  iu  the  prognosis  of  any  given  case, 
for  the  purpose  of  being  able  to  outline  rational  remedial 
measures.  To  be  able  to  distinguish  between  the  generalization 
of  a  septic  infection  in  its  incipiency,  and  a  more  or  less  benign 
edema,  is  largely  possible  by  digital  manipulation  alone.  An 
extremity  may  be  greatly  swollen  because  of  the  existence  of 
chronic  lymphangitis,  influenza,  or  an  acute  septic  infection  oc- 
casioned by  the  introduction  of  pathogenic  and  aerogenic  or- 
ganisms. Since  the  effect  produced  by  these  dissimilar  ailments 
are  productive  of  conditions  that  may  terminate  favorably  or 
unfavorably,  it  becomes  necessary  for  the  diagnostician  to  de- 
velop a  trained,  discriminating,  tactile-digital  sense,  in  order  to 
correctly  interpret  existing  conditions,  and  handle  cases  in 
a  rational  and  skillful  manner. 

In  order  to  ascertain  the  extent  and  exact  location  of  a  tumor, 
an  exostosis,  or  other  enlargements,  the  diagnostician,  here  also, 
needs  to  be  in  possession  of  a  trained  tactile  sense  and  in  addi- 
tion if  he  be  fortified  with  an  accurate  knowledge  of  normal  anat- 
omy and  pathology,  he  is  able  to  arrive  at  proper  conclusions, 
when  digital  manipulations  have  been  employed.  Fibrous  tu- 
mors are  sometimes  located  in  the  inferior  part  of  the  medial 
side  of  the  tarsus — exactly  over  the  seat  of  bone-spavin.  Such 
tumors,  when  the  affected  member  is  supporting  weight,  are  not 
to  be  distinguished  from  exostoses;  but  as  soon  as  the  affected 
leg  ceases  to  bear  weight,  it  may  be  passively  flexed  and  the 
nature  of  the  enlargement  recognized  because  it  may  be  slightly 
displaced  by  digital  manipulation.  Displacement,  of  course,  is 
not  possible  with  an  exostosis. 

A  necessary  qualification,  which  the  diagnostician  must  pos- 
sess, is  that  of  being  able  to  judge  carefully  the  nearness  of  any 
given  exostosis  to  articular  structures.  Also,  the  extent  or  area 
of  the  base  of  an  exostosis  as  well  as  its  exact  position,  needs 
be  determined  before  one  may  estimate  the  probal)le  outcome 
in  any  case, — whether  treatment  should  be  encouraged  or  dis- 
couraged by  the  practitioner.  Periarticular  ringbone  may,  be- 
cause of  the  size  and  location  of  the  exostosis,  constitute  a  con- 
dition Avhich  cannot  be  relieved  in  any  way  in  one  case,  and  in 
another,  because  of  the  manner  of  distribution  of  such  osseous 


DIAGNOSTIC    PRINCIPLES  47 

deposits,  the  eoiulitiou  may  be  such  that  prompt  recovery  will 
follow  proper  treatment.  In  the  examination  of  an  exostosis  of 
the  tarsus,  it  is  particularly  important  to  determine  the  exact 
location  of  the  exostosis — whether  or  not  the  spavin  involves 
the  ti])ial  tarsal  (astragulus)  ])one  very  near  its  tibial  articular 
portions.  Obviously,  if  articular  surfaces  of  joints  are  involved, 
comjilete  recovery  cannot  result  despite  the  most  skillful  atten- 
tion given  the  subject. 

Passive  Movements. 

Wherever  it  is  possible  to  gain  the  confidence  of  a  tractable 
animal  to  the  extent  that  it  will  relax  the  structures  sufficiently 
to  nuike  possible  passive  movement  of  affected  parts,  much  is 
to  be  learned  as  a  result  of  such  manipulation.  By  this  method 
one  may  differeiitiate  true  crepitation,  false  crepitation,  luxation 
and  inflammation  of  ligaments  that  have  been  injured,  as  in 
sprains  of  such  structures  in  the  phalangeal  region. 

True  crepitation  is  recognizable  by  the  characteristic  vibra- 
tion which  is  interjireted  by  tactile  sense.  It  is  possible  to  rec- 
ognize fracture  by  the  use  of  other  methods — auscultation,  tun- 
ing fork  tests,  etc.,  but  in  ordinary  veterinary  practice  one  must 
rely  upon  the  sense  of  touch  for  recognition  of  crepitation. 

Where  pain  is  not  so  great  tliat  relaxation  of  parts  does  not 
occur,  one  can,  by  gently  moving  an  extremity  in  various  di- 
rections— as  in  flexion,  extension  and  lateral  motion  as  well  as  by 
rotation — cause  to  be  manifested  this  peculiar  grating, — the 
friction  of  newly  broken  bone.  This  is  known  as  true  crepitation. 
Where  the  subject,  suffering  phalangeal  fracture,  manifests 
evidence  of  pain  due  to  tensing  the  structures  abinit  a  fractured 
part,  one  may  anesthetize  the  parts  by  using  a1)0ut  two  cubic' 
centimeters  of  a  two  per  cent,  solution  of  cocain  upon  the  plantar 
nerves,  proximal  to  the  fracture.  It  is  perhaps  l)est  to  deposit 
the  cocain  solution  by  means  of  two  hypodermic  punctures  at 
different  points  along  the  course  of  each  nerve,  though  closely 
situated  to  one  another,  thereby  making  more  sure  of  the  so- 
lution actually  contacting  the  nerve.  In  some  multiple  frac- 
tures of  the  first  or  second  phalanx  this  is  quite  necessary; 
otherwise,   pain  produced  by  passive  manipulation  causes  the 


48  LAMENESS  OF  THE  HORSE 

subject  to  keep  the  tendons  so  tense  that  crepitation  may  not 
be  detected.  The  unnecessary  infliction  of  pain  is  always  to  be 
avoided. 

We  know  as  false  crepitation  a  vibrating  impulse  occasioned 
by  normal  contact  of  articular  portions  of  bones  such  as  in  the 
metacarpophalangeal  joint  when  this  structure  is  passively 
moved,  where  the  subject  permits  the  parts  to  remain  in  a  state 
of  complete  relaxation. 

Attempts  to  recognize  supersensitiveness  or  inflammation  by 
means  of  passive  movement  of  the  shoulder  or  hip,  whether 
gently  or  forcefulty,  is  not  productive  of  good,  in  any  case,  in 
large  animals.  Because  of  the  bulk  and  weight  of  parts  so 
manipulated,  a.s  well  as  the  resistance  the  subject  offers  even 
in  normal  cases,  no  accurate  conclusion  is  to  be  arrived  at  in 
this  manner  in  the  average  instance.  Animals  nearly  always 
resist  the  placing  of  members  in  any  position  that  is  so  unusual 
and  uncomfortable  as  that  which  is  required  to  materially  dis- 
place the  component  tissues  of  the  shoulder  or  hip ;  therefore, 
such  ])raetiee  is  useless  because  one  can  not  distinguish  between 
normal  resistance  and  flinching  caused  by  painful  sensations  in 
injured  parts.  Such  manipulations  are  practical  in  small  ani- 
mals. 

Observing  the  Character  of  the  Gait. 

In  order  to  determine  the  degree  of  lameness  as  well  as  its 
character,  it  is  necessary  to  cause  the  s'ubject  which  is  being 
examined,  to  move  in  some  manner.  The  degree  of  inconvenience 
or  distress  experienced  by  a  lame  animal  that  is  being  so  ex- 
amined is  manifested  l)y  the  character  of  the  claudication ;  and 
where  much  pain  is  occasioned  in  locomotion  there  is  disturbance 
of  respiration ;  perspiration  may  be  noticeable  and  in  some  in- 
stances manifestation  of  nervous  shock  are  very  evident — this  in 
timid,  nervous  animals  that  anticipate  being  punished  when 
approached  and,  consequently,  make  every  effort  possible  to 
move  when  urged  to  do  so.  An  animal,  then,  should  be  moved 
only  sufficiently  to  cause  it  to  exhibit  the  degree  of  lameness 
present  in  any  given  case,  and  if  a  marked  impediment  is  mani- 
fested it  is  not  necessary  to  cause  the  subject  to  be  exerted  to 


DIAGNOSTIC    PRINCIPLES  49 

the  extent  of  inflicting,  in  such  manner,  unnece^sai-y  punishment. 
Further  or  conclusive  examination  is  made  by  palpation.  To 
cause  the  subject  to  move,  an  assistant  may  simply  lead  the  ani- 
mal with  a  halter  and  compel  it  to  walk  a  few  steps.  In  this 
way,  lameness,  whether  manifested  during  the  weight-bearing 
period  of  an  alfected  member,  or  when  such  a  meud)er  is  being 
advanced,  or  whether  a  com])ination  of  the  two  conditions  exists, 
is  made  apparent.  In  the  words  of  Dollar,  one  is  thus  enabled 
to  recognize  the  existence  of  "supporting-leg-lameness,"  "swing- 
ing-leg-lameness" or  "mixed  lameness." 

^Yhen  the  cause  of  lameness  is  not  strikingly  apparent  it  be- 
comes necessary  to  have  the  subject  moved  farther  than  a  few 
steps  and  at  different  paces.  Depending  then,  upon  the  charac- 
ter of  lameness  manifested,  as  well  as  upon  its  degree  of  iu- 
tensity,  one  needs  to  exercise  the  subject  in  various  ways,  but 
this  should  not  be  overdone. 

The  first  thing  apparent  in  the  lame  subject  in  action,  is  the 
lame  leg.  If  this  is  not  readily  determinable,  as  in  some  compli- 
cated cases,  the  leg  or  legs  which  are  at  fault  are  to  be  dis- 
covered by  further  examination,  and  to  do  this, — word-pictures 
convey  little  that  is  helpful  in  dif^cult  cases, — long  practice  is 
the  one  route  by  which  one  may  become  efficient;  that  is,  by  ex- 
perience gained  after  fundamental  principles  in  the  diagnosis 
of  lameness  have  been  mastered. 

For  a  careful  study  of  supporting-leg-lameness  involving  a 
fore  limb,  the  subject  is  driven  or  led  toward  the  one  making 
such  examination.  If  a  hind  leg  is  to  be  observed,  the  animal 
is  made  to  travel  (nraij  from  the  examiner.  Where  there  exists 
swinging-leg-lameness,  the  subject  should  be  caused  to  movt 
past  the  diagnostician,  so  that  he  may  get  a  side  view  of  the 
subject  while  it  is  in  motion. 

In  every  case  sucli  examinations  are  made  to  the  best  ad- 
vantage if  the  practitioner  can  view  his  patient  from  a  little 
distance.  Here,  again,  a  visual  examination  is  made  but  this 
cannot  be  successfully  executed,  in  difficult  cases,  if  the  prac- 
titioner is  stationed  at  too  close  range. 

The  average  subject  is  liest  observed  by  being  led,  rather  than 
being  ridden,  and  in  so  doing  the  animal  should  be  given  moder- 


50  LAMENESS  OP  THE  HORSE 

ately  free  rein.  A  close  grasp  on  the  lead  may  interfere  some- 
what with  head  movements.  Nodding  of  the  head  with  the  catch- 
ing up  of  weight  hy  a  sound  member  in  supporting-leg-lameness 
of  a  fore  leg,  constitutes  the  chief  symptom  considered  in  de- 
tecting the  lame  leg. 

Where  supporting-leg-lameness  affects  a  hind  limb  the  head 
is  raised  at  the  time  weight  is  caught  by  the  sound  member — 
here  the  long  axis  of  the  subject's  body  may  be  likened  unto 
a  lever  of  the  first  class.  The  posterior  part  of  the  body,  at  iho 
time  weight  is  taken  upon  the  sound  leg,  is  as  the  long  arm  :  the 
fore  limbs  the  fulcrum,  and  the  subject's  head  the  weight,  which 
is  lifted.  The  head  movements  of  a  horse  at  a  trot,  in  support- 
ing-leg-lameness of  a  front  leg,  synchronize  with  the  discharge  of 
weight  from  a  lame  leg  to  the  opposite  one  if  sound ;  but  in 
pelvic  limb  affections,  the  head  is  thrown  or  jerked  upward  as 
weight  is  caught  by  the  sound  member, — this  peculiar  nodding 
movement  is  opposite  in  the  two  instances. 

In  pacing  horses,  since  front  and  liind  legs  of  the  same  side 
are  advanced  at  the  same  time,  there  occurs  in  supporting-leg- 
lameness,  a  nodding  of  the  head  with  discharge  of  weight  from 
the  lame  leg,  and  a  dropping  of  the  hip  as  weight  is  caught  by 
the  sound  pelvic  member.  In  observing  animals  that  are  limp- 
ing, (as  in  supporting-leg-lameness)  one  notices  particularly  the 
sacro-iliac  region  in  hind  leg  affections  and  the  occipital  region 
in  lameness  of  the  front  legs. 

Where  there  exists  a  bilateral  affection,  (such  as  characterizes 
some  cases  of  navicular  disease  or  other  affections  causing  sup- 
porting-leg-lameness) there  occurs  no  nodding  of  the  head; 
weight  is  supported  for  an  equal  length  of  time  upon  each  one 
of  the  two  legs,  but  the  stride^  is  shortened.  The  gait,  in  such 
cases,  is  peculiar,  animals  appearing  stiff'  and  they  are  said,  by 
horsemen,  to  have  a  "choppy"  gait. 

It  i?  desirable,  in  some  cases,  to  cause  an  animal  to  move  from 
side  to  side;  in  other  instances  the  subject  is  best  made  to  walk 
or  trot  in  a  circle,  and  if  the  circle  be  very  small  the  animal 
then  particularly  employs  the  inner  fore  leg  as  a  pivotal  sup- 


^By  .stiide  i.s  mefuit  the  distance  l)etween  two  successive  imi>rints  of  tlie 
same  foot.  The  term  is  not  used  in  this  work  as  being  synonymous  with 
step. 


DIAGNOSTIC    PRINCIPLES  51 

porting  member.  To  augment  the  manifestation  of  certain  af- 
fections, it  is  necessary  to  cause  the  patient  to  walk  backward, 
and  each  one  of  these  tests  of  locomotion  serves  to  point  out 
in  a  more  or  less  characteristic  manner,  the  site  of  the  affection 
which  is  causing  lameness  in  different  cases. 

Sprains  or  injuries  of  lateral  ligaments  of  the  extremities, 
ringbone  and  certain  foot  aft'ections,  are  made  manifest  by  a 
side  to  side  movement  or  a  pivotal  movement.  In  fact,  wherever 
it  is  possiI)le  to  cause  undue  or  unusual  tension  to  be  exerted 
upon  an  inflamed  structure,  manifestation  of  pain  is  the  re- 
sponse. In  an  inflamed  condition  of  the  lateral  side  of  the  pha- 
langes, unequal  weight-bearing  such  as  a  rough  road  surface  will, 
by  virtue  of  the  leverage  which  the  solar  surface  of  the  foot  af- 
fords, cause  undue  strain  upon  such  inflamed  parts,  and  in- 
creased lameness  is  evident. 

When  an  animal  is  made  to  travel  in  a  circle,  when  a  mem- 
ber affected  with  supporting-leg-lameness  is  on  the  inner  side 
of  the  circle,  lameness  is  accentuated  because  weight  is  borne  by 
the  lame  leg  for  a  greater  length  of  time,  the  result  of  such  cir- 
cuitous manner  of  locomotion.  In  swinging-leg-lameness,  on 
the  other  hand,  because  pain  is  increased  at  the  time  an  affected 
member  is  being  advanced,  lameness  is  increased  when  the  sub- 
ject is  made  to  travel  in  a  circle,  with  the  lame  leg  on  the  out- 
side of  a  circle  thus  described. 

In  supporting-leg-lameness,  the  transientness  of  the  w^eight- 
bearing  period  upon  the  affected  member  is  the  determining 
factor  in  the  production  of  lameness.  This  unequal  period  of 
weight-bearing  upon  the  front  legs,  for  instance,  causes  an  ac- 
celeration in  the  advancement  of  the  sound  member,  in  order  to 
relieve  the  diseased  one  which  is  bearing  weight.  In  other  words, 
when  an  animal  that  is  affected  with  supporting-leg-lameness 
travels  in  a  straight  line,  since  weight  is  borne  by  the  diseased 
leg  for  an  abnormally  short  period  of  time,  the  sound  member 
needs  be  in  the  act  of  advancement  a  correspondingly  short  pe- 
riod. The  result  is  then,  an  une(iual  division  of  stride;  a  nod- 
ding of  the  head  with  the  catching  up  of  weight  by  the  sound 
leg, — in  front  leg  affections — and  this  is  termed  limping. 

With  continuous  exertion  as  in  travel  for  a  considerable  dis- 


52  LAMENESS  OF  THE  HORSE 

tauce,  ill  some  cases,  lanieuess  becomes  less  evident — as  in  sjiavin. 
This  "warming  out"  process  is  due  in  a  measure  to  the  parts 
becoming  less  sensitive  upon  exertion,  and  is  to  be  seen,  to  a 
limited  extent,  in  all  inflammatory  affections  that  are  not  too 
severe;  consequently,  in  some  cases,  examination  of  a  lame  ani- 
mal should  begin  in  the  stall,  for  in  instances  where  the  impedi- 
ment is  not  marked,  there  may  be  no  evidence  of  lameness  after 
the  subject  ha.s  walked  a  few  steps.  In  other  cases,  lameness  in- 
creases as  the  subject  continues  to  travel,  and  often  to  the  ex- 
tent that  tile  impediment  becomes  too  severe  to  allow  the  animal 
being  serviceable.  Therefore,  one  can  not,  in  every  case  of  lame- 
ness observed,  positively  determine  the  gravity  of  the  situation, 
without  having  seen  the  affected  animal  in  action  for  a  sufficient 
length  of  time  to  understand  the  nature  of  the  condition  ex- 
isting. This  necessitates  driving  the  animal  for  several  miles  in 
certain  cases. 

Sometimes  it  is  impossible  to  arrive  at  any  definite  conclusion, 
as  the  result  of  a  single  examination,  and  it  then  becomes  neces- 
sary to  see  the  subject  again  at  a  later  date,  or  under  more 
favorable  circumstances.  This  is  to  be  expected  in  some  con- 
ditions where  there  exists  rheumatic  affections,  and  also  in  some 
foot  diseases. 

In  the  examination  of  young  animals,  unused  to  harness  and 
to  other  strange  incumbrances,  one  is  obliged  to  make  allow^ance 
for  impediments  of  gait,  which  are  not  occasioned  by  diseased 
conditions.  Such  affections  have  been  termed  "false  lameness." 
Young  mules  that  are  not  well  broken  to  harness,  are  difficult  sub- 
jects for  examination  ami  in  some  eases  it  is  necessary  to  have 
them  led  or  driven  for  a  considerable  distance  before  one  can 
definitely  interpret  the  nature  of  the  impediment  in  the  gait  when 
lameness  is  not  pronounced.  Jt  is  especially  difficult  to  satis- 
factorily examine  such  subjects,  for  the  reason  that  their  normal 
rebellious  temperaments  cause  resistance  whenever  a  strange 
person  approaches  them,  as  it  is  necessary  to  do  for  an  examina- 
tion by  palpation.  In  such  cases — if  an  examination  does  not 
reveal  the  cause  of  trouble,  rest  must  be  recommended  and  fur- 
ther examination  made  at  a  later  date,  whereupon  any  new 
developments  iiuiy  be  noted,  if  such  changes  exist. 


DIAGNOSTIC    PRINCIPLES  53 

Special  Methods  of  Examination. 

After  having  coiupk'ted  a  general  examination  of  a  lame  ani- 
mal—obtaining tlie  history  of  the  case,  noting  its  temperament, 
type,  size,  conformation,  position  assumed  while  at  repose,  swell- 
ings or  enlargements  if  present,  causing  the  subject  to  move  to 
note  the  degree  and  character  of  lameness  manifested ;  palpating 
and  manipulating  the  parts  affected  to  acquire  a  fairly  definite 
notion  of  the  nature  of  an  intlannnation  or  to  recognize  crepita- 
tion it  becomes  necessary  in  some  cases  to  employ  peculiar  means 
of  examination  in  singular  instances.  This  may  be  done  by  mak- 
ing use  of  cocain  in  solution  for  the  production  of  local  anes- 
thesia as  in  lameness  of  the  phalanges.  Such  means  are  not,  in 
themselves,  dependable  but  are  valuable  when  used  in  conjunc- 
tion with  all  other  available  and  practical  methods. 

Trial  use  of  various  shoes  in  order  to  shift  the  weight  from 
one  part  of  the  foot  to  another  or  to  cause  an  animal  to  "breali 
over"  in  a  different  uumner  so  that  the  gait  may  be  changed, 
constitutes  a  special  test  procedure.  The  use  of  hoof  testers 
or  of  a  hammer  to  note  the  degree  or  presence  of  supersensi- 
tiveness  is  another  means  that  is  of  practical  service.    No  exam- 


Pig.  i_Hoof  testers  with  special  jaws  of  sufficient  size  to  grasp  the 
largest   foot. 

ination,  in  any  case  of  lameness,  is  complete  without  having  re- 
moved the  shoe  and  scrutinized  the  solar  surface  of  the  foot. 

Diagnosis  by  exclusion,  finally,  is  resorted  to,  and,  as  in  any 
other  case  where  the  recognition  of  cause  is  difficult,  exclusion 
of  the  existence  of  conditions, — one  at  a  time,  by  an  analysis 
of  symptoms — generally  enables  the  practictioner  to  eliminate  all 
but  the  disturbing  element. 


SECTION    IT  I. 
LAMENESS  IN  THE  FORE  LEG. 

Anatomo-Physiological  Review  of  parts  of  the  Fore  Leg. 

For  supporting  weight,  whether  tlie  suhjeet  is  at  rest  or  in 
motion,  the  bony  eolunin  of  the  leg,  together  with  attached  liga- 
ments, tendons  and  muscles,  is  wonderfully  well  adapted  by  na- 
ture for  the  function  which  they  perform.  The  several  bones 
which  go  to  make  up  the  supportive  portion  of  the  leg,  are  so 
joined  at  their  points  of  articulation,  that  a  minimum  degree 
of  strain  is  put  upon  each  attachment. 

The  upper  third  of  the  scapula,  with  its  cartilage  of  prolonga- 
tion, is  sufficiently  broad  and  flattened  that  it  fits  snugly  against 
the  tliorax  without  necessity  for  a  complicated  method  of  attach- 
ment— the  clavicle  l)eing  absent,  attachment  is  muscular. 

Smith^  has  very  aptly  stated  that : 

"It  seems  quite  legitimate  to  regard  the  muscular  union  between 
the  thorax  and  forelimb  as  a  joint.  There  are  no  bones  resting 
on  each  other,  no  synovia  ;  l)ut  where  the  scapula  has  its  largest 
range  of  movement  there  is  a  remarkable  amount  of  areolar 
tissue,  which  renders  movement  easy.  The  whole  central  area 
beneath  the  scapula  and  humerus  not  occupied  by  muscular  at- 
tachment, is  filled  with  this  easy-moving,  apparently  gaseously 
distended,  crepitant,  areolar  tissue  over  which  the  fore  legs  glide 
on  the  chest  wall  as  freely  as  if  the  parts  were  a  large,  well 
lubricated  joint. ' ' 

The  scapulohumeral  articulation  (shoulder  joint)  is  an 
enarthrodial  (ball  and  socket)  joint  but  because  of  its  being 
held  more  or  less  firmly  against  the  thoracic  wall  by  muscular 
and  tendinous  attachment,  and  because  a  part  of  this  attachment 
affords  a  means  of  support  for  the  body  itself,  there  is  no  need 
for  binding  ligaments  and  movement  is  possible  in  all  directions 
even  though  restricted  as  to  extent. 

iManual  of  Veterinary  I'hysiology,  by  Major-General  F.   Smith,   page  .590. 

55 


56 


LAMENESS  OP  THE  HORSE 


Extensor  cnrpi  obliqum, 


Metacarpal  tuberosity  — ^  [\ 
Tendon  from  common  to  lateral  extensor 


Lateral  small  metacarpal  bone 


Branch  of  suspensory  ligament  to 
extensor  tendon 


Olecranon 


Ulnar  head  of  deep  flexor 


Lateral  extensor 
Deep  flexor  (humeral  head) 

Tendon  of  ulnaris  lateralis 
Accessory  carpal  bone 


Check  ligament 

Suspensory  ligament 
Flexor  tendons 


Flexor  tendons 
(Uirtilnge  of  third  phalanx 


Fig.  2 — Muscles  of  Left  Thoracic  Limb  from  Elbow  Downward;  Lateral 
(External)  View. 

a,  Extensor  carpi  radialis;  g,  brachialis:  g',  anterior  superficial  pectoral; 
c,  common  digital  extensor;  e,  ulnaris  lateralis  (After  Ellenberger-Baum, 
Anat.    fiir  Ktinstler.)     (From  Sisson's  "Anatomy  of  the  Domestic  Animals"). 


LAMENESS  IN  THE  FORE  LEG 


57 


Long  head  of  triceps 
Medial  head  of  triceps 

Olecranon 
Ulnar  head  of  deep  flexor  - 


Flexor  carpi  ulnaris 
Flexor  carpi  radiaUa  - 


/       Biceps  brachii 

1- 


Extensor  carpi  radinlis 
■  Long  tendon  of  biceps 
Brachialis 
Long  medial  ligawcnl 


Radius 


Accessory  carpal  hone 
Medial  ligament  of  carpjis 

Superfwial  flf.xnr  tendon 

Deep  flexor  lendon 
Suspensory  ligament 

Distal  end  of  Mc.  II 
Annnl/iT  ligament 

Superficial  flexor  tendon 
Deep  flexor  tendon  . 


Tendon  of  extensor  carpi 
obbquus 

Metacarpal  tuberosity 


Mc.  Ill 


Fetlock  joint 

Extensor  branch  of  suspcnsorii 
ligam.enl 

Common  extensor  tendon 
■  Pastirn  joint 
Cartilage  of  third  phalanx 


Fig.  3 — Muscles  of  Left  Thoracic  Limb  from  Ell)o\v  Dov.-pward;  Medial 
(Internal)   View. 

The  fascia  and  the  ulnar  head  of  the  flexor  carpi  ulnaris  liave  been  re- 
moved. 1,  Distal  end  of  humerus;  2,  median  vessels  and  nerve.  (From 
Sisson's    "Anatomy   of    the    Domestic   Animals"). 


58  LAMENESS  OF  THE  HORSE 

Undue  extension,  (by  extension  is  meant  such  movement  as 
will  cause  the  long  axis  of  two  articulating  bones  to  assume  a 
position  which  approaches  or  forms  a  straight  line — opposite  to 
flexion),  of  the  scapulohumeral  joint  is  impossible  while  weight 
is  borne,  because  of  the  normally  flexed  position  of  the  humerus 
on  the  scapula ;  whereas  flexion,  beyond  desirable  limits,  is  in- 
hibited by  the  biceps  braehii  (flexor  l)rachii  or  coracoradialis) 
muscle. 

The  distal  end  of  the  humerus,  however,  articulating  with  the 
radius  and  ulna  in  a  fashion  that  no  support  is  lent  liy  any  sort 
of  contact  with  the  liody,  is  a  ginglymus  (hinge)  joint  and  later- 
al motion,  because  of  the  long  transverse  diameter  of  its  articular 
]")ortions,  is  easily  prevented  by  the  medial  and  lateral  ligaments 
(internal  and  external  ligaments).  Flexion  of  this,  the  humero- 
radioulnar  joint  (elbow),  is  restrained  by  the  triceps  braehii 
and  extension  is  checked  by  the  biceps  braehii  (flexor  braehii). 

The  carpal  joint  (erroneously  called  the  knee  joint),  is  com- 
posed of  the  several  carpal  bones  which  interarticulate  and, 
when  taken  as  a  group,  serve  as  a  means  of  attachment  and  ar- 
ticulation for  the  radius  and  metacarpal  bones. 

The  transverse  diameter  of  this  joint  is  long,  thus  giving  it 
contacting  surfaces  that  are  sufiiciently  extensive  to  minimize 
the  strain  upon  the  mesial  and  lateral  ligaments  (internal  and 
external  lateral  common  ligaments).  ]\Iotion  is  that  of  flexion 
and  extension ;  slight  rotation  is  possible  when  the  position  is 
that  of  flexion.  While  supporting  weight  the  carpus  is  fixed  in 
position  by  a  slight  dorsal  flexion,  but  undue  dorsal  flexion  is 
prevented  by  the  flexor  muscles  and  tendons  and  volar-carpal  or 
annular  ligament,  together  with  the  superior  cheek  ligament. 

The  metacarpophalangeal  articulation  (fetlock  joint),  is  a 
hinge  joint  and  its  articular  surfaces  contact  one  another,  with 
respect  to  their  having  a  long  bearing  surface  from  side  to  side, 
as  do  all  ginglymus  (hinge)  joints.  Two  common  lateral  liga- 
ments bind  the  bones  together.  AVhile  bearing  weight,  there  is 
assumed  a  position  of  slight  dorsal  flexion,  undue  flexion  being 
checked  by  the  inhibitory  ap])aratus  of  the  joint — cheek  liga- 
ments, and  their  tendons  and  the  suspensory  ligament.  The  in- 
hibitory apparatus  of  the  fetlock  joint  is  materially  reinforced 


LAMENESS   IN  THE  FORE  LEG 


59 


})y  the  proximal  sesamoid  bones.  Situated  as  they  are,  between 
tlie  bifurcatino'  portions  of  the  suspensory  ligament  and  the  pos- 
terior part  of  the  distal  end  of  the  metacarpus — with  which  they 
ai'ticulate — the  sesamoid  bones  serve  to  change  the  course  of  the 


Stin 

Tendon  of  common  exlensoi 

Bursa 

Capsule  of  fetlock  joint 
Cavity  of  fetlock  joint 


Cavity  of  /laslcrti  jmnl 

Cavity  of  coffin  joint         .  ^^ 
Coriinn  of  pcriople  ^^     ^^ / 


I'criopk^S^.     / 
rutin  Jg'--  : 


Middle  scsamoidcan  ligamcjil 

-f^ir/        Digital  synovial  sheath 

lfJJ~~  Cavity  of  pastern  joint 

Superficial  sesamoidean  ligament 

Deep  flexor  tendon 

Distal  end  of  digital  sheath 

—  r2 
11 

Digital  cushion 


Corium  of  sole 

Fig.    4— Sagital   Section   of   Digit   and   Distal    Part   of   Metacarpus. 

A,  Metacarpal  bone;  B,  first  phalanx;  C,  second  phalanx,  D,  third  phalanx; 
E,  distal  sesamoid  bone;  1,  volar  pouch  of  capsule  of  fetlock  joint;  2,  inter- 
sesamoidean  ligament;  3,  4,  proximal  end  of  digital  synovial  sheath;  5. 
ring  formed  by  superficial  flexor  tendon;  6,  fibrous  tissue  underlying  ergot; 
7,  ergot;  8,  9,  9',  branches  of  digital  vessels;  10,  distal  ligament  of  distal 
sesamoid  bone;  11,  suspensory  ligament  of  distal  sesamoid  bone;  12, 
12',  proximal  and  distal  ends  of  bursa  podotrochlearis.  (From  Sisson's 
"Anatomy    of    the    Domestic    Animals"'). 

branches  of  the  suspensory  ligament  in  a  manner  that  they  give 
firm  support  to  this  joint.  Volar  Hexion  is  limited  by  the  ex- 
tensors of  the  phalanges. 

The  first  phalanx   (os  suffraginis)   normally  sets  at  an  angle 


60  LAMENESS  OF  THE  HORSE 

of  about  50  to  55  degrees  from  a  horizontal  plane  while  weight 
is  being  supported.  Its  distal  end  articulates  with  the  second  or 
median  phalanx  (os  corona)  and  forms  the  proximal  inter- 
phalangeal  (pastern  or  sutfraginocoronary)  joint.  This  also, 
is  a  gingiymus  joint,  having  but  slight  lateral  motion,  and  that 
only  when  it  is  in  a  state  of  flexion.  A  rather  broad  articular 
surface — from  side  to  side — exists  here,  lessening  the  strain 
on  the  collateral  ligaments  somewhat.  Dorsal  flexion  is  checked 
by  the  flexor  tendons  and  dorsal  ligaments.  Volar  flexion  is  re- 
strained by  the  extensor  tendons. 

The  distal  end  of  the  second  phalanx  (os  corona)  has  but  slight 
lateral  motion  and  this  is  manifested  principally  when  it  is  in 
a  state  of  volar  flexion.  Undue  dorsal  flexion  is  prevented  by 
the  deep  flexor  tendon  (perforans)  and  volar  flexion  is  inhibited 
by  the  extensor  of  the  digit  (extensor  pedis).  Thus  it  is  seen, 
that  when  the  leg  is  a  weight-bearing  member,  weight  is  sup- 
ported by  the  hony  framework  whose  constituent  parts  are  joined 
together  by  ligaments  and  tendons  and  each  one  of  the  several 
bones  articulates  in  such  manner  that  the  joint  is  locked.  The 
articular  parts  of  bones  rest  upon  or  against  an  inhibitory  ap- 
paratus, and  are  slightly  flexed,  as  in  the  carpus,  or  considerably 
flexed  such  as  in  the  fetlock  joint  when  weight  is  being  sup- 
ported. In  the  first  instance,  for  example,  the  flexors  of  the 
carpus  and  the  superior  check  ligament  assisted  by  the  flexors 
of  the  phalanges  constitute  the  inhibitory  apparatus. 

It  will  be  noted  that  provision  for  weight  bearing  is  so  ar- 
ranged that  muscular  energy  is  not  required  except  in  the  matter 
of  suspension  of  the  body  between  the  scapulae  and  here  tonic 
impulses  only  are  necessary  to  maintain  an  equilibrium^,  yet 
in  every  instance  where  weight  is  not  supported  by  bones,  in- 
elastic ligaments  or  tendinous  structures  relieve  the  musculature 
of  this  constant  strain.  This  explains  the  fact  that  some  horses 
do  not  lie  in  the  stall,  yet  in  spite  of  their  constant  standing 
position,  they  are  able  to  rest  and  sleep. 

The  student  of  lameness  is  interested  in  the  function  of  the 
legs  in  the  role  of  supporting  weight  and  as  propelling  parts, 
and  net  ]i;)rtii'ulai'ly  in  tlic  capacity  of  these  members  for  in- 


^Manual  of  Veterinary  l>hysiolo,a;v  liy  Major-Oeneral   F.   Smith,  page   580 


LAMENESS   IN  THE  FORE  LEG  61 

flicting  offense  or  as  weapons  of  defense.  Yet,  in  the  exercise  of 
their  functions  other  than  that  of  locomotive  appliances,  injury 
often  results,  but  usually  it  is  the  recipient  of  a  blow  that  suffers 
the  injury,  such  as  an  animal  may  receive  upon  being  kicked. 
Therefore,  we  do  not  often  concern  ourselves  with  strains  or  other 
injuries  that  the  subject  experiences  as  the  result  of  efforts  put 
forth  in  kicking  or  striking.  Where  such  injuries  occur,  how- 
ever, a  diagnosis  is  established  l)y  making  use  of  the  principles 
heretofore  discussed. 

As  propelling  members  the  front  legs  bear  weight  and  are 
advanced  alternately  when  the  horse  is  walking  or  trotting — in 
cantering  this  is  not  so.  When  the  normal  subject  travels  in  a 
straight  line,  at  a  walk  or  a  trot,  the  length  of  the  stride  is  the 
same  with  the  right  and  left  nu^nbers.  The  stride  of  the  right 
foot  then,  for  example,  is  equally  divided  by  the  imprint  of  the 
left  foot,  in  the  normal  horse,  when  traveling  at  a  walk  and  in 
a  straight  line. 

Shoulder  Lameness. 

This  enigmatical  term  is  frequently  employed  by  the  diag- 
mostician  when  he  is  baffled  in  the  matter  of  definitely  locating 
the  cause  of  lameness;  when  he  has  by  exclusion  and  otherwise 
arrived  at  a  decision  that  lameness  is  "high  up."  Shoulder 
lameness  may  lie  caused  l)y  any  one  or  several  of  a  number  of 
conditions,  e.  g.,  fractures  of  the  scapula  or  humerus;  arthritis 
of  the  shoulder  or  elbow  joint;  luxation  of  the  shoulder  or  ell)OW 
joint  (rarely)  ;  injuries  of  muscles  and  tendons  of  the  region  due 
to  strains,  contusions  or  penetrant  wounds;  paralysis  of  the 
brachial  plexus  or  of  the  prescapular  nerve;  involvement  of 
lymph  glands;  arterial  thrombosis;  metastatic  infections;  rheu- 
matic disturbances ;  and  as  the  result  of  inflammation,  infectious 
or  non-infectious  occasioned  by  collar  bruises.  In  some  instances 
such  inflammation  is  due  to  the  manner  of  treatment  of  collar 
injuries.  Therefore,  when  one  considers  the  numerous  and  dis- 
similar possible  causes  of  shoulder  lameness,  it  behooves  the  prac- 
titioner to  become  proficient  in  diagnostic  principles. 

A  principle  which  is  elemental  in  the  diagnosis  of  locomotory 
impediment,  is  that  lameness  of  the  shoulder  or  hip  is  usually 


62 


LAMENESS  OF  THE  HORSE 


manifested  by  more  or  less  difficulty  in  swinging  the  affected 
member.  Swinging-leg-lameness,  then,  is  usually  present  in 
shouAder  affections.  In  some  instances  lameness  is  mixed  as  in 
joint  ailments,  involvement  of  the  bicipital  bursa  (bursa  inter- 
tubercularis),  etc.  In  affections  of  the  extremity  there  exists 
supporting  leg  lameness.  Consequently,  we  employ  this  ele- 
mental principle,  and,  by  a  visual  examination  of  the  subject, 
which  is  being  made  to  travel  suital)ly,  one  may  decide  that 
lameness  is  either  "high  up" — shoulder  lameness  or,  "low 
down" — of  the  extremitv. 


Fig.    5 — Ordinary    type   of   heav>-   sling. 

To  make  practical  use  of  this  principle,  the  examiner  must 
be  thoroughly  familiar  with  the  anatomy  of  the  various  struC' 
tures  concerned  in  advancing  the  leg — those  which  support  weight 
as  well  as  those  concerned  l)oth  in  weight  bearing  and  swinging 
the  member. 

Fracture  of  the  Scapula. 

Etiology  and  Occurrence. — Fractures  of  the  body  of  the 
scapula  are  of  infrequent  occurrence  in  horses  for  the  reason 


LAMENESS  IN  THE  FORE  LEG 


63 


that  protection  is  afforded  this  bone  because  of  its  position.  Its 
function,  too,  is  such  that  very  unusual  conditions  are  necessary 
to  subject  it  to  fracture.  The  spine  is  occasionally  broken  due 
to  blows  such  as  kicks,  etc.,  and  here  frequently  a  compound 
fracture  exists. 

"Where  fractures  of  the  body  of  the  scapula  occur,  heavy  con- 
tusions have  been  the  cause  as  a  rule,  and  serious  injury  is  done 
the  subject ;  consequently,  treatment  of  fracture  of  the  body  of 


Fig.  6 — A  sling  made  in  two  parts  so  that  horses  may  be  supported  with- 
out use  of  central  part  or  bodice.  This  sling  is  more  comfortable  than 
is  the  ordinary  style  and  is  particularly  useful  in  cases  that  require  a 
long   period   of   this   manner   of   confinement. 

the  scapula  is  seldom  successfully  practised.  Fractures  of  the 
body  of  this  bone  resulting  from  accidents  not  involving  internal 
injury  or  other  disturbances  and  which  would  not  seriously  inter- 
fere with  the  vitality  of  the  suliject,  are  not  necessarily  serious 
unless  compound. 

Fractures  of  the  neck  of  the  scapula  are  serious  because  of 
the  fact  that  there  occurs  displacement  of  the  broken  parts  and 


64  LAMENESS  OF  THE  HORSE 

perfect  apposition  of  the  fractured  ends  is  difficult,  if  not  ini 
possible. 

Fractures  that  extend  to  the  articular  surface  are  very  seri- 
ous, and  complete  recovery  in  such  instances  is  practically  impos- 
sible. The  cartilage  of  prolongation  of  the  scapula  is  sometimes 
seriously  involved  in  certain  cases  of  fistulous  withers,  and  in 
some  instances  it  has  been  separated  from  its  attachment  to  the 
rhomboidea  muscles,  and  lameness  has  resulted.  In  such  in- 
stances, the  upper  portion  of  the  scapula  is  disjoined  from  all 
attachment,  and  with  every  movement  the  animal  makes,  the 
scapula  is  moved  l)ack  and  forth.  Complete  recovery  in  such 
cases  does  not  occur. 

Symptomatology. — Fractures  of  the  scapular  spine  are  ordi- 
narily readily  recognized  because  there  is  usually  visible  dis- 
placement of  the  broken  part.  Crepitation  is  also  detected  with- 
out difficulty. 

In  fractures  of  the  body  of  the  scapula  where  an  examination 
may  be  made  before  much  swelling  has  taken  place,  and  in  sub- 
jects that  are  not  heavily  muscled,  one  should  have  no  difficulty 
in  recognizing  the  crepitation. 

Fractures  of  the  neck  of  the  scapula  are  recognized  by  crepi- 
tation, by  passively  moving  the  leg,  but  it  is  necessary  to  exclude 
fractures  of  the  humerus  when  one  depends  upon  the  finding  of 
crepitation  by  this  means.  However,  unless  undue  swelling  ex- 
ists, the  exact  location  of  the  crepitation  is  recognized  without 
serious  difficulty. 

Treatment. — The  treatment  of  compound  fractures  of  the 
scapular  spine  consists  in  the  removal  of  the  broken  piece  of 
bone  by  ^^ay  of  a  cutaneous  incision  so  situated  that  good  drain- 
age of  the  wound  will  follow. 

Simple  fractures  of  the  body  of  the  scapula  are  best  treated 
by  placing  the  subject  in  a  sling,  if  the  animal  is  halter  broken, 
and  enforcing  absolute  quiet  for  a  period  of  from  tliree  to  six 
weeks.  Splints  or  similai'  appliances  are  not  of  ])ractical  value 
in  scapular  fractures. 

Compound  fractures  of  tlic  scapula  usually  result  from  vio- 
lence, which  at  the  same  time  does  serious  injury  to  adjacent 


LAMENESS   IN  THE  FORE  LEG  65 

structures,  and  it  then  becomes  necessary  to  administer  an  ex- 
pectant treatment,  observing  general  surgical  principles  and  pro- 
viding in  so  far  as  possible  for  the  comfort  of  the  patient. 

Scapulohumeral  Arthritis. 

Anatomy.— The  scapulohumeral  joint  is  an  enarthrodial  (ball 
and  socket)  joint  wherein  the  ball  or  humeral  articulating  head 
greatly  exceeds  in  size  the  socket  or  glenoid  cavity  of  the  scapula. 
The  capsular  ligament  surrounding  this  joint  is  very  large  and 
admits  of  free  and  extensive  movement  of  the  articulation.  There 
exist  no  lateral  or  common  ligaments  jointing  the  scapula  and 
humerus  as  in  other  joints,  but  instead  the  tendinous  portions 
of  muscles  perform  this  function.  The  principal  ones  which  are 
attached  to  the  scapula  and  humerus  that  act  as  ligaments  are 
the  supraspinatus  (antea-spinatus),  infraspinatus  (postea- 
spinatus)  biceps-brachii  (flexor  brachii)  and  subseapularis  mus- 
cles. 

Etiology  and  Occurrence. — Inflammation  of  the  scapulohum- 
eral articulation  results  from  injuries  of  various  kinds,  including 
punctures  which  perforate  the  joint  capsule,  bruises  from  col- 
lars, metastatic  infections  and  involvement  as  a  result  of  direct 
extension  of  infectious  conditions  situated  near  the  joint. 

Classification.— Acute  arthritis  may  be  septic  or  aseptic,  and 
there  seems  to  be  a  remarkalile  tendency  for  recovery  in  cases 
of  septic  arthritis  involving  this  joint  in  the  horse. 

Chronic  arthritis  with  destruction  of  articular  surfaces  and 
ankylosis,  is  seldom  observed.  It  is  only  in  cases  of  severe  in- 
jury, where  the  articular  portions  of  the  bones  are  damaged  at 
the  time  of  infliction  of  the  injury,  and  where  the  articulation 
remains  exposed  for  weeks  at  a  time,  together  with  immobility 
of  the  parts  because  of  attending  pain,  that  permanent  ankylosis 
results. 

Scapulohumeral  arthritis  may  result  then  from  infections,  local 
or  metastatic;  from  injuries,  such  as  contusions  of  various  kinds; 
from  wounds,  which  break  the  surface  structure  or  perforate 
the  joint  capsule;  or  from  luxations. 


66  '  LAMENESS  OF  THE  HORSE 

Infectious  Arthritis. 

Infectious  arthritis  of  the  scapulohumeral  joint  the  result  of 
local  causes  other  than  produced  by  septic  wounds,  seldom  causes 
serious  inconvenience  to  the  subject.  "Where  such  occurs,  how- 
ever, there  is  manifested  mixed  lameness  and  complete  extension 
of  the  extremity  is  impossible.  Local  swelling  is  present  and 
manifestations  of  pain  are  evident  upon  palpation  of  the  affected 
area. 

Treatment. — During  the  first  stage  of  the  infection,  local  ap- 
plications, hot  or  cold,  are  indicated.  A  hot  poultice  of  bran 
or  other  suitable  material  contained  within  a  muslin  sack,  may 
be  supported  by  means  of  cords  or  taj^es  which  are  passed  over 
the  withers  and  tied  around  the  opposite  fore  leg.  Such  an 
appliance  may  be  held  in  position  more  securely  by  attaching 
it  to  the  affected  member.  Following  the  acute  stage  of  such  an 
infection,  any  local  counter-irritating  application  or  even  a 
vesicant  is  in  order. 

Where  abatement  of  the  infectious  process  does  not  take  place, 
and  suppuration  of  the  structures  in  the  vicinity  of  the  joint 
occurs,  it  is  necessary  to  provide  drainage  for  pus.  In  some 
cases  of  strangles,  for  instance,  large  pus  cavities  are  formed 
and  drainage  is  imperative.  However,  metastatic  inflammation 
of  this  joint  is  seldom  observed  except  in  cases  of  strangles. 
The  animal  should  be  kept  perfectly  quiet  until  recovery  has 
taken  place. 

Injuries. 

Injuries  to  the  scapulohumeral  joint  may  be  the  result  of 
kicks,  runaway  accidents  or  bruises  from  the  collar,  and  there 
may  result,  because  of  such  injuries,  reactionary  inflammation 
which  will  vary  in  intensity  from  the  mildest  synovitis  to  the 
most  severe  arthritis,  causing  more  or  less  lameness. 

Treatment. — The  general  plan  of  treatment  in  this  form  of 
arthritis  is  the  same  as  has  been  outlined  under  the  head  of  in- 
fectious arthritis,  with  the  exception  that  there  is  seldom  occa- 
sion to  provide  for  drainage  of  pus. 


LAMENESS   IN  THE  FORE  LEG  67 

Wounds. 

Wounds  which  cause  a  break  of  the  skin  and  fascia  overlying 
the  scapulohumeral  joint  are  usually  of  little  consequence,  unless 
the  blow  is  of  sufficient  force  to  directly  injure  the  articulation, 
and  in  such  cases,  the  treatment  of  the  injury  along  general  sur- 
gical principles,  such  as  cleansing  the  area,  providing  drainage 
for  wound  secretion,  and  the  administration  of  suitable  dress- 
ing materials  such  as  antiseptic  dusting  powder,  is  all  that  is 
required  for  the  wound.  The  symptoms  manifested  by  the  sub- 
ject in  such  cases  are  the  same  as  have  been  discussed  hereto- 
fore and  merit  no  special  consideration. 

Prognosis. — Unless  very  serious  injury  be  done  the  articular 
portions  of  the  scapula  or  the  humerus,  resulting  in  the  destruc- 
tion of  the  capsular  ligament,  prognosis  is  entirely  favorable. 

Open  Joint. — AVliere  the  capsular  ligament  is  perforated  and 
the  condition  becomes  one  of  open  joint,  then  a  special  wound 
treatment  becomes  necessary.  The  surface  of  the  skin  is  first 
freed  from  all  hair  and  filth  in  the  vicinity  of  the  wound.  The 
wound  proper  is  cleared  of  all  foreign  material  either  by  clipping 
with  the  scissors,  curetting  or  mopping  with  cotton  or  gauze 
pledgets.  The  whole  exposed  wound  surface  as  well  as  the  in- 
terior of  the  joint  cavity,  if  much  exposed,  is  moistened  with 
tincture  of  iodin.  Subsequent  treatment  consists  in  a  local  appli- 
cation of  a  desiccant  dusting  poAvder,  which  should  be  applied 
five  or  six  times  daily.  The  composition  of  the  powder  should 
be  such  as  to  permit  of  its  liberal  use,  thereby  affording  mechan- 
ical protection  to  the  wound  as  well  as  exerting  a  desiccative 
effect.  Equal  parts  of  boric  acid  and  exsiccated  alum  serve 
very  well  in  such  cases. 

Animals  suffering  from  open  joints  of  this  kind  should  be 
confined  in  a  standing  position,  preferably  in  slings,  and  kept 
so  confined  for  three  or  four  weeks.  Since  they  usually  bear 
weight  upon  the  affected  member,  there  is  no  danger  of  lamin- 
itis  resulting. 

Luxation  of  the  Scapulohumeral  Joint. 

Because  of  the  large  humeral  head  articulating  as  it  does  with 


68  LAMENESS  OF  THE  HORSE 

a  glenoid  cavity,  scapulohumeral  luxations  are  very  rare  in  the 
horse.  According  to  Moller^,  luxation  is  generally  due  to  exces- 
sive flexion  of  the  scapulohumeral  joint.  In  such  cases  the  head 
of  the  humerus  is  displaced  anterior  to  the  articular  portion  of 
the  scapula  and  remains  so  fixed. 

Symptoms. — Complete  luxation  of  the  scapula  is  recognized 
because  of  innnobility  of  the  scapulohumeral  joint  and  of  the 
abnormal  position  of  the  head  of  the  humerus,  which  can  be  rec- 
ognized by  palpation,  unless  the  swelling  be  excessive.  Immo- 
bility of  the  scapulohumeral  joint  is  noticeable  when  one  attempts 
to  passively  move  the  parts. 

Treatment. — Reduction  of  the  luxation  is  effected  by  mak- 
ing use  of  the  same  general  principles  that  are  employed  in  the 
reduction  of  all  luxations,  and  they  are — the  control  of  the  ani- 
mal so  that  the  manipulations  of  the  operator  are  not  antagon- 
ized by  muscular  contraction,  which  is  best  accomplished  by 
anesthesia;  placing  the  luxated  bones  in  the  position  which  they 
have  taken  to  become  unjointed ;  and  then  making  use  of  force 
which  is  directed  in  a  manner  opposite  to  that  which  has  effected 
the  luxation. 

In  a  forward  luxation  of  this  kind,  the  operator  should  further 
flex  the  humerus,  and  while  it  is  in  this  flexed  position,  force  is 
exerted  upon  the  articular  head  of  this  bone,  and  it  is  pushed 
downward  and  backward  into  its  normal  position. 

After-care  consists  in  restriction  of  exercise  and,  if  necessary, 
confining  the  subject  in  a  sling  and  the  application  of  a  vesicant 
over  the  scapulohumeral  region. 

Inflsunmation  of  the  Bicipital  Bursa. 
( Bursitis  Intertuberculeuis. ) 

Anatomy. — There  is  interposed  between  the  tendon  of  the 
biceps  brachii  (flexor  brachii)  and  the  intertubercular  or  bicipi- 
tal groove  a  heavy  cartilaginous  pad,  which  is  a  part  of  the  bursa 
of  the  biceps  brachii.  This  synovial  bursa  forms  a  smooth  groove 
through  wliicli  tlie  l)ieeps  braelni  glides  in  the  anterior  scapulo- 


'Regional  Veterinary  Surgery  and  Operative  Technique,   .Tno.  A.  W.  Dollar, 
M.  R.  C.  V.  S.,  F.  R.  S.  E.,  M.  R.  I.,  page  765. 


LAMENESS   IN  THE  FORE  LEG  69 

humeral  region.  Great  strain  is  put  upon  these  parts  because 
the  biceps  brachii  is  the  chief  inhibiting  structure  of  the  scapu- 
lohumeral articulation— the  one  which  prevents  further  flexion 
of  the  luimerus  during  weight  bearing.  Passing,  as  it  does,  over 
two  articulations,  the  biceps  brachii  has  a  somewhat  compli- 
cated function,  being  a  flexor  of  the  radius  and  an  extensor  of 
the  humerus.  Thus  it  is  seen,  the  biceps  brachii  is  a  weight  bear- 
ing structure,  as  well  as  one  that  has  to  do  with  swinging  the  leg. 
Etiology  and  Occurrence. — Because  of  the  exposed  position 
of  the  bicipital  bursa  (bursa-intertubercularis)  it  is  occasionally 
injured.  Blows  and  injuries  received  in  runaway  accidents  do 
serious  injury  to  the  bursa  and  because  of  the  peculiar  and  im- 
portant part  it  plays  during  locomotion,  serious  injuries  are 
not  likely  to  resolve,  and  too  often  chronic  lameness  results.  It 
is  to  be  noted  that  the  tendon  of  the  biceps  brachii  (flexor  bra- 
chii) is  always  involved  in  cases  of  inflammation  of  the  bicipital 
bursa,  and  according  to  the  late  Dr.  BelP  strain  of  the  biceps 
brachii  is  a  frequent  cause  of  lameness  in  city  horses,  more  fre- 
quent than  is  generally  supposed. 

Pathological  Anatomy. — ]\Iore  or  less  destruction  of  the  car- 
tilaginous portion  of  the  bursa,  sometimes  involving  the  tendin- 
ous portion  of  the  biceps,  takes  place  and,  according  to  MoUer, 
in  some  instances  there  occurs  ossification  of  the  tendon.  Autop- 
sies in  some  old  horses  reveal  the  presence  of  erosions  of  carti- 
lage and  hyperthrophy  of  the  inflamed  parts. 

Symptoms. — In  acute  inflammations,  there  is  always  marked 
lameness.  This  is  manifested  to  a  greater  degree  when  the  sub- 
ject advances  the  affected  leg.  There  is  incomplete  advancement 
of  the  member;  the  toe  is  dragged  when  the  horse  is  made  to 
walk  and  the  foot  kept  in  a  position  posterior  to  the  opposite  or 
weight  bearing  foot  while  the  suliject  is  at  rest.  Lameness  is 
disproportionate  to  the  amount  of  local  manifestation  in  the  way 
of  heat,  swelling  and  pain  that  is  to  be  recognized  on  palpation. 
In  fact,  in  some  cases  so  much  pain  attends  the  condition  that 
no  weight  is  borne  liy  the  affected  member,  and  when  compelled 
to  walk,  the  subject  hops  on  the  sound  leg. 

iDr.  Roscoe  R.  Bell  in  the  Proceedings,  N.  Y.  State  Veterinary  Medical 
Society,   1899. 


70  LAMENESS  OF  THE  HORSE 

Chronic  inflammation  of  the  bicipital  bursa  is  occasionally  met 
with  wherein  both  members  are  afiPected.  Because  of  the  nature 
of  the  structures  involved,  when  inflamed,  chronic  inflammation 
is  a  more  frequent  termination  than  is  complete  recovery.  Bi- 
lateral affections  are  seen  in  horses  that  are  driven  for  years, 
regularly  at  a  fast  pace  on  paved  streets.  In  such  cases,  the 
gait  is  stilted,  that  is,  there  is  incomplete  advancement  of  both 
members  and,  of  course,  the  period  of  weight  bearing  is  cor- 
respondingly shortened;  hence  the  short  strides. 

In  chronic  cases,  little  if  any  evidence  of  inflammation  is  to 
be  detected  by  digital  manipulation  of  the  parts.  If  flinching 
occurs,  one  is  often  unable  to  interpret  the  manifestation  as  to 
whether  it  is  due  to  inflammation  or  not. 

There  is  no  marked  "warming  out"  in  this  condition,  and  ani- 
mals are  nearly  as  lame  after  having  been  driven  a  considerable 
distance  as  when  started,  although  the  lameness  is  not  as  a  rule 
very  great. 

Treatment. — In  very  painful  cases  acute  inflammation  is 
treated  by  employing  cold  applications  during  the  initial  stage. 
Cracked  ice  when  contained  in  a  suitable  sack  may  be  held  in 
contact  with  the  affected  part  and  the  pack  is  supported  by 
means  of  cords  or  tapes  as  suggested  in  the  discussion  on  treat- 
ment of  scapulohumeral  arthritis  on  page  66.  Later,  hot  appli- 
cations may  be  employed  to  good  advantage. 

In  the  course  of  ten  days  or  two  weeks,  if  the  acute  painful 
condition  has  entirely  subsided,  vesication  is  indicated.  The 
ordinary  mercury  and  cantharides  combination  does  very  well. 
Depending  upon  the  course  taken  in  any  given  case,  one  is  guided 
in  the  treatment  employed.  If  prompt  resolution  comes  to 
pass,  the  subject  may  be  given  free  run  at  pasture  after  three 
or  four  weeks  confinement  in  a  box  stall.  If,  however,  the  case 
does  not  progress  in  a  prompt  and  satisfactory  manner,  abso- 
lute quiet  must  be  enforced  for  six  weeks  or  more.  Kepeated 
blistering  is  beneficial,  although  it  is  doubtful  if  firing  is  of 
sufficient  benefit  in  the  average  chronic  case  of  intertubercular 
bursitis  to  justify  the  punishment  which  this  form  of  treatment 
inflicts,   unless  infliction   of   pain   is  the   thing  sought,   to   en- 


LA.MENESS   IN  THE  FORE  LEG  71 

force  repose  in  restless  subjects.  Patients  are  best  given  a  long 
rest  at  pasture  and  returned  to  work  for  two  or  three  months 
after  an  acute  attack  of  inflammation  of  the  bursa,  lest  the  con- 
dition become  chronic.  When  due  consideration  is  given  the 
pathology  of  such  cases,  the  frequent  unsatisfactory  termination 
under  the  most  careful  treatment,  is  readily  understood. 

Contusions  of  the  Triceps  Brachii. 
( Triceps  Extensor  Brachii :  Caput  Muscles. ) 

Anatomy. — The  triceps  brachii  is  the  principal  structure 
which  fills  the  space  between  the  posterior  border  of  the  scapula 
and  the  humerus.  The  several  heads  originate  for  the  most  part 
on  the  border  of  the  scapula,  the  deltoid  tuberosity  of  the  hu- 
merus and  the  shaft  of  the  humerus.  Insertion  of  this  large 
muscular  mass  is  effected  by  means  of  several  tendons  to  the 
olecranon.  A  synovial  bursa  is  situated  underneath  the  ten- 
dinous attachment  of  the  posterior  portion  of  the  triceps  brachii 
— the  long  head  or  caput  magnum. 

The  function  of  the  triceps  as  a  whole  is  to  flex  the  shoulder 
joint  and  extend  the  forearm.  The  triceps  brachii  is  the  chief 
antagonist  of  the  biceps  brachii. 

Etiology  and  Occurrence. — Owing  to  the  exposed  position  of 
this  structure,  it  is  not  infrequently  contused,  the  result  of  falls, 
kicks  and  other  injuries.  The  function  of  the  triceps  is  such 
that  it  becomes  strained  upon  rare  occasions  Avhen  a  horse  resists 
confinement  of  restraint  in  such  manner  that  the  parts  are  un- 
duly tensed  in  contraction.  This  sort  of  resistance  may  stretch 
the  radial  nerve  or  its  branches  in  a  way  that  paralysis  results. 
A  condition  known  as  "dropped  elbow"  is  described  by  Henry 
Taylor,  F.  R.  C.  V,  S.,  in  the  Veterinary  Record^  wherein  a 
two-year-old  colt  while  resisting  confinement  was  so  injured. 

The  triceps  group  because  of  its  convenient  location,  consti- 
tutes the  site  for  hypodermic  injection  of  drugs  and  biologic 
agents,  with  some  practitioners;  and  as  a  result,  more  or  less 
inflammation  may  occur.  The  author  has  observed  and  treated 
some  twenty  cases  where  an  intensely  painful  infectious  inflam- 

lAmerican  Veterinary  Review,  Vol.  35,  P.  456. 


72  LAMENESS  OF  THE  HORSE 

mation  of  the  triceps  brachii  was  caused  by  the  intramuscular 
injection  of  a  caustic  solution  by  a  cruel  and  unscrupulous  em 
piric,  whose  object  was  to  increase  his  practice. 

Symptomatology. — As  the  triceps  brachii  is  not  particularly 
taxed  during  weight  bearing  in  the  su])ject  at  rest,  there  may 
be  no  unnatural  position  assumed  during  inflammation  of  the 
triceps.  More  or  less  swelling  and  supersensitiveness  is  always 
present,  however,  and  great  care  and  discrimination  must  be  ex- 
ercised in  digital  manipulation  of  the  triceps  region  because 
many  animals  are  normally  sensitive  to  palpation  of  these  parts. 
It  is  sometimes  difficult  to  correctly  interpret  the  true  state  of 
conditions  because  of  this  peculiarity. 

There  is  always  swinging-leg-lameness,  which  is  accentuated 
when  the  subject  is  urged  to  trot.  AVhere  symptoms  are  pro- 
nounced, it  is  unnecessary  to  cause  the  subject  to  move  at  a 
faster  pace  than  at  a  walk  to  recognize  the  condition.  The  for- 
ward stride  is  shortened  and  in  extremley  painful  conditions,  no 
attempt  is  made  to  extend  the  leg.  It  is  simply  carried  en  une 
pipce — flexion  of  the  shoulder  and  elbow  joints  is  carefully 
avoided. 

Treatraient. — During  the  early  stage  of  inflammation,  hot  or 
cold  applications  are  beneficial.  Long  continued  use  of  moist 
heat — fomentations — allays  pain  and  stimulates  resolution.  Keep- 
ing in  contact  with  the  painfully  swollen  parts  a  suitable  bag 
filled  with  bran,  which  can  be  moistened  at  intervals  with  warm 
water,  constitutes  a  practical  and  easy  means  of  treatment.  By 
employing  this  method,  one  is  more  likely  to  succeed  in  having 
his  patient  properly  cared  for,  in  that  less  work  is  entailed  than 
if  hot  fomentations  are  prescribed. 

After  the  acute  and  painful  stage  has  subsided,  a  stimulating 
liniment  is  of  benefit.  The  subject  should  be  kept  within  a  com- 
fortable and  roomy  box  stall  for  a  sufficient  length  of  time  to 
favor  prompt  resolution.  Wild  and  nervous  subjects,  if  not  so 
confined,  will  i)i-()1)ably  overexert  the  affected  parts  if  allowed 
the  freedom  of  a  paddock  or  pasture. 

Where  the  inflammation  liecomos  infective,  surgical  interfer- 
ence is  necessary.    The  prompt  evacuation  of  pus,  with  adequate 


LAMENESS   IN  THE  FORE  LEG  73 

provision  for  wound  discharge,  should  be  attended  to  before 
extensive  destruction  of  tissue  takes  place.  Resolution  is  prompt 
as  a  rule  in  such  cases  because  of  the  vascularity  of  the  struc- 
tures and  the  ease  with  which  proper  drainage  may  be  effected. 
No  special  after-care  is  necessary  if  drainage  is  perfect,  ex- 
cept that  one  should  avoid  injecting  the  wound  cavity  with 
aqueous  solutions  unless  it  be  absolutely  necessary  to  cleanse 
such  cavity,  and  then  it  is  best  to  swab  the  wound  rather  than 
to  irrigate  it  freely. 

Shoulder  Atrophy. 
(Sweeny  or  Swinney) 

No  satisfactory  consideration  of  the  pathogeny  of  this  condi- 
tion is  recorded,  but  practitioners  have  long  distinguished  be- 
tween muscular  atrophies  which  are  apparently  caused  without 
doing  serious  injury  to  nerves  and  muscular  atrophy  which 
seems  to  be  due  to  nerve  affection.  In  the  first  instance,  recov- 
ery Avhen  proper  attention  is  given,  is  prompt;  whereas,  in  the 
latter,  regeneration  of  the  wasted  tissues  requires  months  in 
spite  of  the  best  sort  of  treatment. 

The  parts  more  frequently  affected  are  the  supra-  and  infra- 
scapularis  (antea-  and  posteaspinatus)  muscles.  But  in  some 
cases  the  triceps  group  is  involved;  however,  this  occurs  in  un- 
usual and  chronic  affections.  No  doubt,  these  chronic  cases  are 
due  to  suspended  innervation  and  are  not  to  be  classed  with 
the  ordinary  case  of  atrophy  of  the  aliductor  muscles  of  the 
liumerus  (supra-  and  infraspinatus)  as  in  the  usual  case  of 
"sweeny." 

Occurrence. — Shoulder  atrophy  such  as  the  general  practi- 
tioner commonly  meets  with,  is  an  affection,  more  often  seen  in 
young  animals  and  it  seems  to  be  due  to  injuries  of  various  kinds 
which  contuse  the  muscles  of  the  shoulder.  Ill-fitting  collars 
and  pulling  in  a  manner  that  there  occurs  side  draft  with  un- 
usual strain  on  the  muscles  of  one  side  of  the  neck  and  shoulder, 
seem  to  be  the  more  frequent  causes  of  this  trouble.  Blows  such 
as  are  occasioned  by  kicks  and  falls  frequently  result  in  atrophy 
of  shoulder  muscles. 


74  LAMENESS  OF  THE  HORSE 

Course. — In  some  eases  a  rapidly  progressive  atrophy  char- 
acterizes the  case  and  lameness  and  atrophy  appear  at  about 
the  same  time.  The  affection  in  such  instances  does  not  re- 
cover spontaneously  but  constitutes  a  condition  which  requires 
prompt  and  rational  treatment  so  that  function  may  be  fully 
restored  to  the  parts  involved. 

Occasionally  one  may  observe  cases  where  there  is  but  slight 
atrophy;  where  the  disease  progresses  slowly  and  atrophy  is 
not  extensive  or  marked.  In  vigorous  young  animals  that  are 
left  to  run  at  pasture  when  so  mildly  affected,  spontaneous  re- 
covery occurs. 

Symptomatology. — Lameness  is  the  first  manifestation  of 
shoulder  atroi3hy,  and  in  many  cases  where  lameness  is  slight, 
the  veterinarian  may  fail  to  discover  the  exact  nature  of  the 
trouble  if  he  is  not  very  proficient  as  a  diagnostician  of  lame- 
ness or  if  he  is  careless  in  taking  into  consideration  obtainable 
history,  age  of  the  subject,  etc.  Because  of  the  fact  that  the 
average  layman  believes  that  practically  every  case  of  fore-leg 
lameness  wherein  it  is  not  obvious  that  the  cause  is  elsewhere, 
is  due  to  a  shoulder  affection  of  some  kind,  we  may  be  too  hasty 
in  giving  the  client  assurance  that  no  "sweeny"  exists.  In  some 
of  these  cases  where  a  diagnosis  of  "shoulder  lameness"  has 
been  made  and  the  client  has  been  assured  that  no  sweeny  exists, 
the  patient  is  returned  in  about  a  week  and  there  is  then  marked 
atrophy  of  one  or  both  of  the  spinatus  muscles. 

A  mixed  type  of  lameness  characterizes  this  affection,  and  in 
the  average  case  there  exists  little  evidence  of  local  pain.  The 
salient  points  in  recognizing  the  condition  are  a  consideration 
of  history  if  obtainable ;  age  of  the  subject ;  finding  slight  local 
soreness,  by  carefully  manipulating  the  muscles  which  are  usu- 
ally involved;  noting  the  character  of  the  lameness  if  any  is 
present ;  and  where  atrophy  is  evident,  of  course,  the  true  con- 
dition is  obvious. 

Treatment. — Sulx-iitanooiis  injections  of  (M|ual  parts  of  re- 
fined oil  of  turpentine  and  alcoliol,  with  a  suitable  hypo- 
dermic syringe,  is  a  practical  and  ordinarily  effective  treatment. 
From  five  to  fifteen  cubic  centimeter.s  (the  quantity  varies  with 


LAMENESS   IN  THE  FORE  LEG  75 

the  size  of  the  animal),  of  this  mixture  is  injected  into  the  atro- 
phied parts  at  different  points,  taking  care  to  introduce  only 
about  one  to  two  cubic  centimeters  at  each  point  of  injection. 
The  syringe  should  be  sterile  and,  needless  to  say,  the  site  of 
injections  must  be  surgically  clean. 

Other  agents,  such  as  tincture  of  iodin,  solutions  of  silver 
nitrate,  saline  solutions  and  various  more  or  less  irritating  prep- 
arations have  been  employed ;  but  in  the  use  of  these  preparations 
one  may  either  fail  to  stimulate  sufficient  inflammation  to  cause 
regeneration  to  take  place,  or  infection  is  apt  to  occur.  Where 
suppuration  results,  surgical  evacuation  of  pus  must  be  promptly 
effected  else  large  suppurating  cavities  form. 

The  employment  of  setons  constitutes  a  dependable  method  of 
treatment  of  shoulder  atrophy,  but  because  of  the  attendant  sup- 
purative process  which  inevitably  results,  this  method  is  not 
popular  with  modern  surgeons  and  is  a  last  resort  procedure. 

After-care. — Regular  exercise  such  as  the  horse  usually  takes 
when  at  pasture,  is  very  helpful  in  treating  atrophy,  and  in  some 
cases  it  has  been  found  that  no  reasonable  amount  of  irritation 
would  stimulate  muscular  regeneration;  but  by  later  allowing 
patients  to  exercise  at  will,  recovery  took  place  in  a  satisfactory 
manner.     No  special  attention  is  ordinarily  necessary. 

Paralysis  of  the  Suprascapular  Nerve. 

Anatomy. — The  suprascapular  (anterior  scapular)  nerve,  a 
small  branch  of  the  brachial  plexus,  is  given  off  from  the  an- 
terior portion  of  this  plexus.  The  nerve  rounds  the  anterior 
border  of  the  neck  of  the  scapula,  passing  upward  and  backward 
under  the  supraspinatus  (antea-spinatus)  muscle  and  terminat- 
ing in  the  infraspinatus  (postea-spinatus)  muscle. 

Etiology  and  Occurrence. — As  the  result  of  direct  injury  to 
this  nerve  by  contusion  such  as  may  be  received  in  runaway 
accidents,  collar  bruises,  especially  collar  bruises  in  young  horses 
that  are  not  accustomed  to  pulling  and  that  walk  in  a  manner 
to  cause  side  draft,  injury  to  the  nerve  occurs,  and  partial  or 
complete  paralysis  supervenes.  Some  writers  state  that  it  may 
be  produced  by  confining  an  animal  in  recumbency,  with  the 


76 


LAMENESS  OF  THE  HORSE 


casting  harness.  The  common  cause  of  paralysis  or  paresis  of 
this  nerve  in  cases  such  as  one  observes  in  country  practice,  is 
bruises  from  the  collar  in  colts  that  are  put  to  heavy  farm  work 
or  whore  ill  fitting  collars  are  used. 

Symptomatology. — With  partial  or  complete  suspension  of 
function  of  the  suprascapular  nerve  there  results  enervation 
of  the  supraspinatus  and  infraspinatus  muscles.  Since  these 
muscles  act  as  external  lateral  ligaments 
of  the  scapulohumeral  joint,  when  they 
are  incapacitated,  there  naturally  fol- 
lows more  or  less  abduction  of  the 
shoulder  Avhen  weight  is  borne. 

In  extreme  cases,  as  soon  a.!,  the  ailing 
animal  is  caused  to  support  w^eight  with 
the  affected  member,  the  joint  is  sud- 
denly thrown  outw^ard  in  a  manner  that 
the  average  layman  at  once  concludes 
that  there  must  be  scapulohumeral  luxa- 
tion, and  the  veterinarian  receives  a  call 
to  see  a  case  wherein  the  "shoulder  is 
out  of  place."  There  exists,  however,  no 
luxation  in  such  cases. 

If  serious  injury  is  done  the  nerve  so 
that  it  undergoes  degenerative  changes, 
there  will  result  atrophy  of  the  muscles 
that  derive  their  nerve  supply  from  the 
suprascapular  nerve. 

Treatment. — During  the  hrst  few  days 
following  injuries  wiiich  result  in  this 
form  of  paralysis,  it  is  Avell  to  keep  the  subject  inactive,  and 
if  much  inflammation  of  the  injured  structures  contiguous  to 
the  nerve  exists,  the  application  of  cold  packs  is  beneficial. 
Later,  as  soon  as  acute  inflammation  has  subsided,  vesication 
of  a  liberal  area  around  the  anteroexternal  part  of  the  scapu- 
lohumeral joint  and  over  the  course  of  the  suprascapular  nerve, 
W'ill  stimulate  recovery  in  favorable  cases.  As  a  rule,  in  mild 
cases,  the  subject  is  in  a  condition  to  return  to  Avork  in  two  or 
three  weeks. 


Fig.  7 — Paralysis  of  the 
.suprascapular  nerve  of 
the  left   shoulder. 


LAMENESS   IN  THE  FORE  LEG  77 

Radial  Paralysis. 

Described  under  the  titles  of  "Radial  Paralysis"  and  "Bra- 
chial Paralysis,"  there  is  to  be  found  in  veterinary  literature 
a  discussion  of  conditions  which  vary  in  character  from  the 
almost  insignificant  form  of  paresis  to  the  incurably  affected  con- 
ditions wherein  the  whole  shoulder  is  completely  paralyzed. 

When  one  considers  the  anatomy  of  the  brachial  nerve  plexus 
and  the  distribution  of  its  various  branches,  the  location  of  this 
plexus  and  its  proximity  to  the  first  rib,  and  the  inevitable  in- 
jury it  must  suffer  in  fracture  of  this  bone,  together  with  the 
inaccessibility  of  the  plexus,  it  is  not  strange  that  a  correct 
diagnosis  of  the  various  affections  of  the  brachial  plexus  and 
the  radial  nerve  is  often  impossible  until  several  days  or  weeks 
have  passed.  And,  in  some  instances,  diagnosis  is  not  established 
until  an  autopsy  has  been  performed.  Here,  too,  we  fail  to  find 
cause  for  paralysis  in  some  rare  instances. 

Anatomy. — The  radial  nerve  is  a  large  branch  of  the  brachial 
plexus  and  is  chiefly  derived  from  the  first  thoracic  root  of  the 
plexus  and  is  here  situated  posterior  to  the  deep  brachial  artery. 
It  is  directed  downward  and  backward  ander  the  subscapularis 
and  teres  major  muscles,  rounding  the  posterior  part  of  the 
humerus,  and  passing  to  the  anterior  and  distal  end  of  the 
humerus,  it  finally  terminates  in  the  anterior  carpal  region.  The 
radial  nerve  supplies  branches  to  the  three  heads  of  the  triceps 
brachii,  to  the  common  and  lateral  extensors  of  the  digit  and  also 
to  the  skin  covering  the  forearm. 

Etiology  and  Occurrence.— Nothing  definite  is  known  about 
the  cause  of  some  forms  of  radial  paralysis.  However,  radial 
paralysis  is  encountered  following  injury  to  the  nerve  occasioned 
by  its  being  stretched,  as  in  cases  where  the  triceps  brachii  is 
unduly  extended  in  restraining  subjects  by  means  of  a  casting 
harness.  Berns^  states  that  in  confining  horses  on  an  old  oper- 
ating table  where  it  was  necessary  to  draw  the  affected  foot  for- 
ward twenty-four  to  thirty-six  inches  in  advance  of  its  fellow. 


i"Radial  Paralysis  and  Its  Treatment  by  Mechanical  Fixation  of  Knee  and 
Anltle,"  Geo.  H.  Berns,  D.  V.  S.  Proceedings  of  the  American  Veterinary 
Medical  Association,    1912,   i).   219. 


78 


LAMENESS  OF  THE  HORSE 


which  was  secured  in  a  natural  vertical  position,  radial  paralysis 
of  a  mild  form  was  of  frequent  occurrence.  Country  practi- 
tioners, in  restraining  colts  by  casting  with  harness  or  ropes, 
occasionally  observe  a  form  of  paresis  wherein  the  radial  nerve 
suffers  sufficient  injury  that  there  is  caused  a  temporary  loss  of 
function  of  the  triceps  brachii.     Such  cases  recover  within  three 


Fig.   8 — Radial  paralysis. 

or  four  days  and  are  not  a  true  paralysis,  but  nevertheless  con- 
stitute conditions  wherein  normal  nerve  function  is  temporarily 
suspended. 

Symptoms. — Immediately  subsequent  to  injuries  which  in- 
volve the  radial  nerve,  there  is  manifested  more  or  less  impair- 
ment of  function.  Remembering  the  structures  supplied  by  the 
radial  nerve  and  its  branches,  one  can  readily  understand  that 
there  should  occur  as  Cadiot^  has  stated : 


^As  quoted   bv   Bcrns,    in  Radial    Paralysis,   etc.,    Proceedings  of   the   A.    V. 
ivr.  A.,  1912. 


LAMENESS   IN  THE  FORE  LEG 


79 


In  complete  paralysis,  the  joints  of  the  affected  limb  with  the 
exception  of  the  shoulder  are  usually  flexed  when  the  horse  is 
resting.  In  consequence  of  loss  of  power  in  the  triceps  and  an- 
terior ])rachial  muscles,  the  arm  is  extended  and  straightened  on 
the  shoulder,  the  scapulohumeral  angle  is  open,  and  the  elbow 
depressed.  The  forearm  is  flexed  on  the  arm  by  the  contraction 
of  the  coracoradialis  (biceps  brachii),  while  the  metacarpus  and 
phalanges  are  bent  by  the  action  of  the  posterior  antibrachial 
iiuiscles.  The  knee  is  carried  in  advance,  level  with,  or  in  front 
of,  a  vertical  line  dropped  from  the  point  of  the  shoulder.  The 
hoof  is  usually  rested  on  the  toe,  but  when  advanced  beyond  the 
above   mentioned   vertical   line,   it   may   be   placed   flat   on   the 


Fig.  9 — Merillat'.s  method  of  fixing  carpus  in  radial  paralysis.  Courtesy, 
Alex.    Eger. 

ground,  the  joints  then  being  less  markedly  bent.  When  the 
limb  as  a  whole  is  flexed,  it  may  be  brought  into  normal  position 
by  thrusting  back  the  knee  with  sufficient  force  to  counteract  the 
action  of  the  flexor  muscles. 

When  made  to  walk,  the  animal  l)eing  unable  to  exert  muscular 
action  with  the  paralyzed  structures,  limply  carries  the  member 
as  a  whole,  and  there  is  shortening  of  the  anterior  portion  of 
the  stride.  There  ])eing  loss  of  function  of  the  triceps  brachii, 
it  is  impossible  for  the  subject  to  straighten  the  leg  in  the  normal 
position  for  supporting  weight ;  therefore,  any  attempt  to  bear 


80  LAMENESS  OF  THE  HORSE 

weight  results  in  further  flexion  of  the  affected  member  and  the 
animal  will  fall  if  the  body  is  not  suddenly  caught  up  with  the 
sound  leg. 

Differential  Diagnosis. — In  making  examination  of  these 
cases,  one  can  exclude  fracture  by  absence  of  crepitation  and 
usually,  also,  swelling  is  absent  in  radial  paralysis.  In  a  typical 
case  of  radial  paralysis,  the  affected  leg  can  sustain  its  normal 
share  of  weight  if  placed  in  position,  that  is,  if  the  carpal  joint 
is  extended  in  such  manner  that  the  leg  is  positioned  as  in  its 
normal  weight-bearing  attitude.  In  brachial  paralysis,  whether 
due  to  fracture  of  the  first  rib  or  to  other  serious  injury,  it  is 
impossible  for  the  subject  to  support  weight  with  the  affected 
member  even  when  it  is  passively  placed  in  position. 

No  difficulty  is  ordinarily  experienced  in  differentiating  radial 
paralysis  from  muscular  injuries  to  the  triceps;  yet,  in  some 
cases  of  ' '  dropped  elbow, "  it  is  necessary  to  observe  the  progress 
of  the  case  for  ten  days  or  two  weeks  before  one  can  positively 
establish  a  diagnosis. 

Quoting  Merillat^:  "When,  after  four  weeks,  there  is  no 
amelioration  of  the  paralysis,  the  muscles  have  atrophied,  and 
the  patient  has  become  emaciated  from  pain  and  discomfort,  the 
diagnosis  of  brachial  paralysis  with  fracture  of  the  first  rib  may 
tlicn  be  announced." 

Prognosis. — AVhen  no  complete  paralysis  of  the  l)rachial 
plexus  or  no  fracture  of  the  first  rib  exists,  the  majority  of  cases 
recover  completely  in  from  ten  days  to  six  weeks.  Some  writers 
claim  that  recoveries  occur  in  ninety  per  cent  of  cases  when 
conditions  are  favorable. 

Treatment. — A\nien  incomplete  radial  paralysis  exists,  little 
needs  be  done  except  to  allow  the  subject  moderate  exercise  and 
to  provide  for  its  comfort.  Local  applications,  stimulative  in 
character,  are  beneficial,  and  the  internal  administration  of 
strychnin  is  indicated. 

In  the  cases  where  weight  is  not  supported  without  the  affected 
leg  being  passively  placed  in  position,  it  is  necessary  to  provide 
for  the  subject's  comfort  in  several  ways. 

Mechanical   appliances  such  as  braces  of  some  kind  in  order 


^Veterinary  Surgical  Operations,   by  L.  A.  Merillat,  V.   S.,  p.   507. 


LAMENESS   IN  THE  FORE  LEG  81 

to  keep  the  affected  leg  in  a  position  of  carpal  extension,  consti- 
tute the  essential  part  of  treatment.  The  leg  is  supported  in 
such  a  manner  that  flexion  of  the  carpus  is  impossible.  Due  re- 
gard is  given  to  prevent  chafing  or  pressure  necrosis  by  contact 
of  the  skin  with  the  braces — this  may  be  done  by  bandaging  with 
cotton.  The  supportive  appliance  is  kept  in  position  for  ten 
days  or  two  weeks.  At  the  end  of  this  time  the  brace  may  be 
removed  and  the  subject  given  a  chance  to  walk,  and  improve- 
ment, if  any  exists,  will  be  evident.  When  there  is  manifested 
an  amelioration  of  the  condition,  moderate  daily  exercise  and 
massage  of  the  affected  parts  are  helpful. 

Should  the  subject  be  seriously  inconveuienced  by  the  applica- 
tion of  a  brace  or  other  supportive  appliances,  it  is  necessary 
to  employ  slings.  Further,  if  weight  is  supported  entirely  by 
the  unaffected  member,  laminitis  may  supervene  if  a  sling  is  not 
used. 

Thrombosis  of  the  Brachial  Artery. 

Thrombosis  of  the  brachial  artery  or  of  its  i^rincipal  branches 
is  of  very  rare  occurrence  in  horses. 

Etiology. — Partial  or  complete  obstruction  of  arteries 
(brachial  or  others)  occurs  as  the  result  of  direct  injury  to  the 
vessel  wall  from  compression  and  tension  of  muscles  and  re- 
sultant arteritis ;  lodging  of  emboli ;  and  parasitic  invasion  of 
vessel  walls  causing  internal  arteritis. 

Symptomatology. — If  sufficient  collateral  circulation  exists  to 
supply  the  parts  with  blood,  no  inconvenience  is  manifested  while 
the  subject  is  at  rest.  Where  the  lumen  of  the  affected  vessel 
is  not  completely  occluded,  there  may  be  no  manifestation  of 
lameness  when  the  ailing  animal  is  moderately  exercised.  Con- 
sequently, the  degree  of  lameness  depends  upon  the  extent  of 
the  obstruction  to  circulation ;  and,  likewise,  the  course  and 
prognosis  depend  upon  the  character  and  extent  of  such  obstruc- 
tion. 

In  severe  eases,  lameness  is  markedly  increased  by  causing 
the  animal  to  travel  at  a  fast  pace  for  only  a  short  distance.  There 
are  evinced  symptoms  of  pain,  muscular  tremors  and  sudation, 
but  the  affected  member  remains  drv  and  there  is  a  marked  dif- 


82  LAMENESS  OP  THE  HORSE 

ference  of  temperature  between  the  normal  areas  and  the  cool 
anemic  parts.  When  the  subject  is  allowed  to  rest,  circulation 
is  not  taxed,  and  there  is  a  return  to  the  original  and  apparently 
normal  condition,  only  to  recur  again  with  exertion.  This  con- 
dition characterizes  thrombosis. 

Treatment. — In  these  cases,  little  if  any  good  directly  results 
from  any  sort  of  treatment  in  the  way  of  medication.  Abso- 
lute rest  is  thought  to  be  helpful.  Potassium  iodid,  alkaline 
agents  such  as  ammonium  carbonate  and  potassium  carbonate, 
have  been  administered.  Circulatory  stimulants  also  have  been 
given,  but  it  is  doubtful  if  any  good  has  come  from  medication. 

Fracture  of  Humerus. 

The  shaft  of  the  humerus,  protected  as  it  is  by  heavy  muscles, 
is  not  frequently  fractured;  and  fractures  of  its  less  protected 
parts,  as  for  example,  the  head,  are  complicated  in  such  manner 
that  resultant  arthritis  soon  constitutes  the  more  serious  condi- 
tion. 

As  a  result  of  falls  on  frozen  ground,  kicks  or  any  other  form 
of  heavy  contusion,  the  humerus  is  occasionally  broken.  It  is 
rarely  fractured  otherwise.  Because  of  the  force  of  contusions 
usually  required  to  effect  humeral  fracture,  the  manner  in  which 
the  bone  is  broken,  with  respect  to  direction,  is  variable.  Often 
oblique  fractures  exist  and  occasionally  there  occurs  multiple 
fracture.  In  addition  to  the  ordinarily  serious  nature  of  the 
fracture  itself,  there  is  always  much  injury  done  the  adjoining 
structures. 

Sjrmptomatology. — Mixed  lameness  and  manifestation  of 
severe  pain  characterize  this  affection.  Considerable  swelling 
which  increases,  in  some  cases  for  a  week  or  more,  is  to  be  ob- 
served. Crepitation  is  readily  detected,  if  pain  and  swelling  is 
not  too  great  to  prevent  passive  movement  of  the  member. 
Where  intense  pain  is  not  manifested,  because  of  manipulation, 
one  may  abduct  the  extremity  and  thereby  occasion  distinct 
crepitation;  but  when  it  is  po-ssible  to  recognize  crepitation  by 
liolding  the  hand  in  contact  with  the  olecranon  while  tlie  animal 
is  made  to  walk,  this  method  is  to  be  preferred,  if  the  su])ject 


LAMENESS   IN  THE  FORE  LEG  83 

can  move  without  serious  difficulty.  The  pathognomonic  symp- 
tcmi  here  is  recognition  of  crepitation,  but  this  may  be  very  diffi- 
cult to  recognize  in  fracture  of  condyles,  and  in  such  instances, 
a  careful  examination  is  necessary.  Gentle  manipulation  in  a 
manner  that  pain  is  not  aggravated  will  tend  to  inspire  confi- 
denee  on  the  part  of  the  subject  and  relaxation  of  muscles  will 
enable  the  operator  to  detect  crepitation. 

Course  and  Prognosis. — Because  of  the  direction  of  the  long 
axis  of  the  humerus,  with  relation  to  the  bony  column  of  the 
extremity,  it  is  obvious  that  any  lateral  movement  of  the  leg 
tends  to  rotate  the  shaft  of  this  bone.  In  fractures  of  the  shaft 
of  the  humerus,  then,  it  is  apparent  that  immobilization  is  very 
difficult  if  at  all  possible. 

The  proximity  to  the  axillary  lymph  glands  makes  for  easy 
dissemination  of  infection  when  the  contused  musculature  be- 
comes infected.  The  adjacent  brachial  nerve  plexus  is  so  very 
apt  to  become  involved,  if  not  actually  injured  at  the  time  frac- 
ture occurs,  that  paralysis  is  a  probable  complication.  Conse- 
quently, it  is  logical  to  reason  that  because  of  the  many  possilile 
serious  complications,  such  as  shock,  occasioned  by  the  injury 
and  the  distress  and  pain  which  this  accident  produces,  recov- 
ery must  be  the  exception  in  fracture  of  the  humerus.  How- 
ever, recoveries  do  take  place  and  in  addition  to  the  reported 
recoveries  by  Liautard,  ]Moller,  Stockfleth,  Lafosse,  Frohner  and 
others,  we  have  instances  cited  by  American  practitioners  where 
cases  resulted  in  recovery.  Thomp.son^  reports  a  good  recovery 
in  a  1600-pound  mare  where  there  existed  an  oblique  fracture 
of  the  humerus.  This  mare  was  kept  in  slings  for  eight  weeks. 
Walters-  reports  complete  recovery  in  humeral  fracture  in  a  foal 
three  days  old.  The  only  treatment  given  was  the  application 
of  a  pitch  plaster  from  the  top  of  the  scapula  to  the  radius. 
The  colt  was  kept  in  a  comfortable  box  stall  and  in  about  four 
weeks  regained  use  of  the  leg.  Complete  recovery  eventually 
resulted.  In  the  experience  of  the  author,  recovery  has  not  oc- 
curred in  humeral  fractures. 


^A  paper  presented  before  the  Illinois  Veterinary  Medical  Assn.  by  Dr.  H. 
Thompson  of  Paxton,  Ul.,  American  Veterinary  Review,   Vol.   15,  p.   134. 

-"Fractures  in  Foals,"  by  Dr.  Wilfred  Walters,  M.  R.  C.  V.  S.,  American 
Journal  of  Veterinary  Medicine,  Vol.   S,  p.    669. 


84  LAMENESS  OF  THE  HORSE 

Treatment. — "When  animals  are  not  aged  and  of  sufficient 
value  to  justify  treatment,  they  are  best  supported  in  a  sling,  if 
halter  broken.  If  subjects  are  nervous,  wild  and  unbroken,  it 
is  possible  to  employ  the  sling,  if  care  is  given  to  train  the  ani- 
mal to  this  manner  of  restraint.  The  presence  of  an  attendant 
for  a  day  or  two  will  reassure  such  subjects  so  that  even  in 
these  cases  it  may  be  j^racticable  to  employ  the  sling. 

Braces  and  other  mechanical  appliances  intended  to  immobi- 
lize the  parts  are  not  of  practical  benefit  in  the  horse.  Unlike 
the  dog,  the  horse  as  yet  has  not  been  successfully  subjected  to 
tolerating  rigid  braces  for  the  shoulder  and  hip. 

Everything  possible  must  be  done  that  will  make  for  the  pa- 
tient's comfort.  If  the  subject  turns  out  to  be  a  good  self  nurse, 
and  the  nature  of  the  fracture  is  such  that  practical  apposition 
of  the  broken  ends  of  bone  may  be  maintained,  recovery  will 
occur  in  some  cases. 

Inflammation  of  the  Elbow. 
(Arthritis.) 

Affections  of  this  articulation  other  than  those  which  are  pro- 
duced by  traumatism  are  rare.  This  joint  has  wide  articular 
surfaces,  and  securely  joined  as  they  are  by  the  heavy  medial 
and  lateral  ligaments  (internal  and  external  lateral  ligaments), 
luxation  is  practically  impossible.  When  luxation  does  occur, 
irreparable  injury  is  usually  done.  Castagne  as  quoted  by 
Liautard^  reports  a  case  of  true  luxation  of  the  elbow  joint  in  a 
horse  where  reduction  was  effected  and  complete  recovery  took 
place  at  the  end  of  twenty-five  days.  This  is  an  unusual  case. 
The  average  practitioner  does  not  meet  with  such  instances. 

Anatomy. — The  condyles  of  the  humerus  articulate  with  the 
glenoid  cavities  of  the  radius  and  a  portion  of  the  ulna.  Two 
strong  collateral  ligaments  pass  from  the  distal  end  of  the  hu- 
merus to  the  head  of  the  radius.  The  capsular  ligament  is  a 
large,  loose  membrane  which  encloses  the  articular  portion  of  the 
humerus  with  the  radius  and  ulna  and  also  the  radioulnar  articu- 
lation.    It  is  attached  anteriorly  to  the  tendon  of  the  biceps 


^American  Veterinary  Review,  Vol.  26,  p.  1068. 


LAMENESS   IN  THE  FORE  LEG  85 

bracliii  (flexor  braehii).  The  capsule  extends  downward  be- 
neath the  origin  of  these  digital  flexors.  This  fact  should  be 
remembered  in  dealing  with  puncture  woimds  in  the  region,  lest 
an  error  be  made  in  estimating  their  extent  and  an  open  joint 
be  overlooked  at  the  initial  examination. 

Etiology  and  Occurrence. — Exclusive  of  specific  or  metastatic 
arthritis,  which  is  seldom  observed  except  in  young  animals,  in- 
flammation of  the  elbow  joint  is  usually  caused  by  injury.  This 
articulation  is  not  subject  to  pathologic  changes  due  to  concus- 
sion or  sprains  as  occasioned  by  ordinary  service,  but  is  fre- 
quently injured  by  contusion  from  falls,  blows  from  the  wagon- 
pole  and  kicks.  Wounds  which  affect  the  elbow  joint,  then,  may 
be  thought  of  in  most  cases,  as  resultant  from  external  violence. 
They  may  be  contused  wounds  or  penetrant  wounds.  Sharp 
shoe-calks  afford  a  means  of  infliction  of  penetrant  wounds  which 
may  occasion  open  joint  and  infectious  arthritis. 

Classification.— A  practical  manner  of  classifying  inflamma- 
tion of  the  elbow  is  on  an  etiological  basis.  Eliminating  the 
forms  of  elbow  inflammation,  such  as  are  caused  by  metastatic 
infection  and  other  conditions  which  properly  belong  to  the  do- 
main of  theory  of  practice,  we  may  consider  this  affection  under 
the  classification  of  contusive  wounds  and  penetrative  tvounds. 

Symptomatology. — Any  injury  which  is  of  sufficient  violence 
to  occasion  inflannnation  of  the  elbow  causes  marked  lameness 
and  manifestation  of  pain.  The  degree  of  lameness  and  distress 
manifested  by  the  subject,  depends  upon  the  nature  and  extent 
of  the  involvement.  A  contusion  suffered  as  the  result  of  a  fall, 
which  occasions  a  circumscribed  inflammation  of  the  structures 
covering  this  joint  and  where  little  inflammation  of  the  articu- 
lating parts  exists,  marked  evidence  of  pain  and  lameness  might 
be  absent.  On  the  other  hand,  if  a  true  arthritis  is  incited,  there 
will  be  evident  distress  manifested,  .such  as  hurried  respiration, 
accelerated  pulse,  inappetence,  mixed  lameness,  local  evidence 
of  inflammation  and  particularly  marked  supersensitiveness  of 
the  affected  parts.  Considering  these  two  extremes  of  manifested 
distrcvss  and  injury,  one  may  readily  conclude  that  in  the  fre- 
quently seen  case,  wherein  contusion  has  occasioned  a  moderate 


8G  LAMENESS  OF  THE  HORSE 

degree  of  injury,  prognosis  is  favorable  and  recovery  ordinarily 
follows  in  the  course  of  a  few  weeks'  treatment. 

In  cases  of  arthritis  due  to  penetrative  wounds  (because  of 
the  important  function  of  this  joint  and  its  large  capsule,  which 
when  intlamed  discharges  synovia  in  a  manner  that  closure  of 
such  an  open  joint  is  seldom  possible)  a  very  grave  condition 
results. 

Treatment. — Inflammation  of  the  elbow,  such  as  is  frequently 
seen  in  general  practice  where  horses  are  turned  out  together 
and  exposed  to  kicks  and  other  injuries,  yields  to  treatment 
readily,  if  an  open  joint  does  not  exist. 

Hot  packs  supported  in  contact  with  the  elbow  and  kept  around 
the  inflamed  articulation  for  a  few  days,  materially  decrease  pain 
and  tend  to  reduce  inflammation.  The  subject  must  be  kept 
quiet  in  a  comfortable  stall  and,  if  necessary,  a  sling  used. 
Where  it  is  impossible  for  the  animal  to  support  much  weight 
with  the  injured  member  the  sling  should  be  employed. 

As  inflammation  abates,  which  it  does  in  the  course  of  from 
one  to  three  weeks  in  uncomplicated  cases,  the  subject  may  be 
allowed  the  freedom  of  a  comfortable  box  stall.  Vesication  of 
the  parts  is  in  order,  and  this  may  be  repeated  in  the  course  of 
two  weeks,  if  it  is  deemed  necessary. 

Penetrative  wounds  resulting  in  open  joint  are  not  treated 
with  success  as  a  rule,  and  because  of  the  handicap  under  which 
veterinarians  labor,  methods  of  handling  such  cases,  where  large, 
important  articulations  are  affected,  are  not  being  rapidly  im- 
proved. Prognosis  is  usually  unfavorable,  and  for  humane  and 
economic  reasons,  animals  so  affected  should  be  destroyed. 

Ordinary  wounds  of  the  region  of  the  elbow  are  treated  along 
general  lines  usually  employed.  They  merit  no  special  consid- 
eration, except  that  it  may  be  mentioned  that  with  such  injuries 
concomitant  contusion  of  the  parts  occasions  injury  that  does 
not  recover  quickly. 

Fracture  of  the  Ulna. 

Etiology  and  Occurrence. — Fractures  of  the  ulna  in  the  horse 
are  not  connuon  in  s|)ite  of  the  exposed  position  of  the  olecranon. 
This  bone  when  broken,  is  usually  fractured  by  heavy  blows 


LAMENESS  IN  THE  PORE  LEG  «7 

and  any  form  of  nlnar  fracture  is  serious  because  of  its  function 
and  position  in  relation  to  the  joint  capsule.  Transverse  frac- 
tures do  not  readily  unite  because  of  the  tension  of  the  triceps 
muscles,  which  prevent  close  approximation  of  the  broken  ends 
of  the  bone. 

Thompson^,  however,  reports  a  case  of  transverse  simple  frac- 
ture of  the  ulna  in  a  mare,  the  result  of  a  kick,  in  which  com- 
plete recovery  took  place.  He  kept  the  subject  in  a  sling  for 
six  weeks  and  then  allowed  six  months  rest. 

Symptomatology. — The  position  assumed  by  a  horse  sutfer- 
ing  from  a  transverse  fracture  of  the  ulna,  is  similar  to  that  in 
radial  paralysis.  Crepitation  may  be  detected  by  manipulating 
the  parts,  and  in  some  instances  of  fracture  of  the  olecranon, 
there  occurs  marked  displacement  of  the  broken  portions  of  the 
bone.  Lameness  is  intense  and  the  parts  are  swollen  and  super- 
sensitive. The  capsular  ligament  of  the  elbow  joint  is  usually 
involved  in  the  injury  because  fracture  of  the  ulna  may  directly 
extend  within  the  capsular  ligament.  In  such  cases,  there  is 
synovitis,  and  later  arthritis  causes  a  fatal  termination. 

Treatment. — The  impossibility  of  applying  a  bandage  in  any 
way  to  practically  immobilize  these  parts  in  fracture  of  the  ulna, 
prevents  our  employing  bandages  and  splints.  Therefore,  one 
can  do  little  else  than  to  put  the  patient  in  a  sling  and  try  to 
keep  it  quiet  and  as  nearly  comfortable  as  circumstances  allow. 

Fracture  of  the  Radius. 

Etiology  and  Occurrence. — From  heavy  lilows  received  such 
as  kicks,  collision  with  trees  or  in  falls  in  runaway  accidents,  the 
radius  is  occasionally  fractured.  In  very  young  foals,  fracture 
of  the  radius,  as  well  as  of  the  tibia  and  other  bones,  results 
from  their  being  trampled  upon  by  the  mother. 

Symptomatology. — Excepting  in  some  cases  of  radial  frac- 
ture of  foals  where  considerable  swelling  has  taken  place,  there 
is  no  difficulty  in  readily  recognizing  this  condition.  The  heavy 
brachial  fascia  materially  contri])utes  to  the  support  of  the  ra- 


iPractures,    bv   H.    Thomp.son,    Paxton,    III.,    American    Veterinary    Review, 
Vol.   15,  p.  134. 


88  LAMENESS  OF  THE  HORSE 

dius,  and  in  cases  where  swelling  is  marked,  crepitation  may  not 
be  readily  detected.  In  fact,  a  sub-periosteal  fracture  may  exist 
for  several  days  or  a  week  or  more  and  then,  with  subsequent 
fracture  of  the  periosteum,  crepitation  and  abnormal  mobility 
of  the  member  are  to  be  recognized.  In  such  cases,  the  subject 
will  bear  some  weight  upon  the  affected  member,  but  this  causes 
much  distress.  In  one  instance  the  author  observed  a  trans- 
verse fracture  of  the  lower  third  of  the  radius  which  was  not 
positively  diagnosed  until  about  ten  days  after  injury  was  in- 
flicted. In  this  case,  without  doubt,  the  subject  originally  suf- 
fered a  sub-periosteal  fracture  of  the  bone  and  because  the  animal 
was  a  good  self  nurse,  the  brachial  fascia  supported  the  radius 
until  the  periosteum  gave  way  and  the  leg  dangled.  In  this 
instance  infection  took  place  and  suppuration  resulted.  It  was 
deemed  advisable  to  destroy  this  animal. 

""  Prognosis. — In  adult  animals,  radial  fracture  constitutes  a 
grave  condition;  generally  speaking,  prognosis,  in  such  cases,  is 
unfavorable.  Because  of  the  leverage  afforded  by  the  extremity, 
immobilization  of  the  radius  is  difficult.  Any  sort  of  mechanical 
appliance,  which  will  immobilize  these  parts,  is  likely  to  produce 
pressure-necrosis  of  the  soft  structures  so  contacted.  There  is 
occasioned  thereby  much  pain  and  the  subject  becomes  restive, 
unmanageable  and  sometimes  the  splints  are  completely  deranged 
because  of  the  animal's  struggles,  and  much  additional  injury 
to  the  leg  is  done.  Occasionally,  an  otherwise  favorable  case  is 
thus  rendered  hopelessly  impossible  to  handle,  and  the  subject 
must  be  destroyed  several  days  after  treatment  has  been  insti- 
tuted. 

Consequently,  unless  all  conditions  are  good,  and  the  affected 
animal  a  favorable  subject,  young,  of  good  disposition,  and  the 
fracture  a  simple  transverse  one,  complete  recovery  is  not  likely 
to  result  from  any  practical  means  of  handling. 

Treatment. — Mature  subjects  ought  to  be  put  in  slings  and 
kept  so  restrained  throughout  the  entire  time  of  treatment. 
Immobilization  of  the  broken  parts  of  the  bone  is  the  object 
sought.  This  is  attempted  by  practitioners  who  employ  various 
methods,  and  each  method  has  its  advocates. 


LAMENESS   IN  THE  FORE  LEG  89 

Casts  are  used  by  some  and  serve  very  well  in  many  cases ;  but 
because  of  their  bulk  and  unyielding  and  rigid  nature,  they  are 
not  well  adapted  to  use  on  fractures  of  bones  proximal  to  the 
carpus  and  tarsus.  This  is  in  reference  to  plaster-of-paris  casts 
or  those  of  any  similar  material. 

Appliances  which  depend  on  glue  or  other  adhesive  substances 
combined  with  leather,  wood  or  fiber  for  their  support,  are  effi- 
cacious but  not  comfortable. 

The  use  of  heavy  leather  when  the  member  has  been  suitably 
padded  with  cotton  and  bandages,  constitutes  a  very  good  man- 
ner of  reducing  fracture  of  the  radius  or  of  the  tibia.  Leather 
when  cut  to  fit  both  the  medial  and  lateral  sides  of  a  leg,  and 
firmly  held  with  bandages,  will  form  a  firm  support  that  yields 
slightly  to  changes  of  position,  thus  making  for  comfort  of  the 
subject. 

Such  a  splint  or  support  should  extend  from  the  fetlock  region 
to  the  elbow,  but  the  cotton  and  bandages  are  to  reach  to  the 
foot.  When  one  considers  that,  with  the  supportive  appliance 
placed  on  each  side  of  the  affected  member,  rigidity  is  accom- 
plished as  much  from  tensile  strain  put  upon  the  leather  as  from 
its  own  stiffness,  it  is  seen  that  the  leather  need  not  be  of  the 
heaviest — sole  leather  is  unnecessary.  Because  of  the  more  com- 
fortable immobilizing  appliance,  the  subject  is  less  restive,  and 
chances  for  a  successful  outcome  are  materially  increased 
thereby. 

In  the  mature  subject,  six  or  eight  weeks'  time  is  required 
for  union  of  the  parts  to  occur  suf^ciently  so  that  splints  may 
be  dispensed  with.  Rearrangement  of  the  supportive  apparatus, 
however,  is  possible  and  usually  necessary  during  the  first  few 
weeks  of  treatment.  By  employing  care  in  handling  the  parts, 
the  subject  will  be  unlikely  to  do  itself  injury  at  the  time  read- 
justment of  splints  is  being  effected. 

In  foals,  it  is  best  to  give  them  the  run  of  a  box  stall  with 
the  mother.  Being  agile,  they  get  up  and  lie  at  will  without 
doing  injury  to  the  fractured  member.  The  splints  (leather  is 
preferable  in  these  cases  also)  are  looked  after  and  readjusted 
as  necessity  demands. 

Three  or  four  weeks  time  is  all  that  is  required  for  the  average 


90  LAMENESS  OF  THE  HORSE 

young  colt  to  be  kept  in  splints  when  suffering  from  simple 
transverse  fracture  of  the  radius. 

Compound  fractures  are  necessarily  more  difficult  to  treat 
than  are  the  simple  variety,  but  even  in  such  cases  recovery  re- 
sults sometimes,  and  the  practitioner  is  justified  in  attempting 
treatment  after  having  explained  the  situation  to  his  client. 

Oblique  fractures,  even  when  simple,  do  not  completely  recover, 
^luscular  and  tendinous  contraction,  together  with  the  natural 
tendency  for  the  beveled  contacting  parts  of  the  broken  bone  to 
pass  one  another  in  oblique  fracture,  results  in  shortening  of  the 
leg  and,  if  union  results,  a  large  callus  usually  forms.  Where 
shortening  of  bones  occur,  necessarily,  permanent  lameness 
follows. 

Wounds  of  the  Anterior  Brachial  Region. 

Etiology  and  Occurrence. — Contusions  and  lacerations  of  the 
forearm  are  of  fre(|uent  occurrence  in  horses  and  are  troublesome 
cases  to  handle;  particularly  is  this  noticeable  where  extensive 
laceration  of  the  parts  occurs.  These  injuries  are  caused  by 
animals  being  kicked;  by  striking  the  forearm  against  bars  in 
jumping;  and  in  sections  of  the  country  where  barbed  wire  is 
used  to  enclose  pastures,  extensive  lacerated  wounds  are  met 
with  when  horses  jump  into  such  fences. 

Symptomatology. — Any  wound  which  causes  inflammation 
of  the  structures  of  the  anterior  half  of  the  forearm,  is  charac- 
terized by  swinging-leg-lameness.  Depending  upon  the  nature 
and  extent  of  the  injury,  manifestation  varies.  In  cases  where 
laceration  has  practically  divided  all  of  the  substance  of  the 
extensor  tendons,  it  is,  of  course,  impossible  for  the  subject  to 
advance  the  leg ;  but  where  lacerated  wounds  involve  only  a  part 
of  the  extensor  apparatus  of  the  foreleg,  not  so  much  inconveni- 
ence is  evident,  unless  the  wound  is  seriously  infected  and  inflam- 
mation involves  contiguous  structures.  Therefore,  in  many  in- 
stances, lameness  is  more  pronounced  in  contusions  of  the  an- 
terior brachial  region  than  where  tissues  have  been  divided  more 
or  less  keenly. 

In  every  instance  diagnosis  is  easily  established.  The  injury 
is  quite  evident,  and  the  nu^nner  of  locomotion  is  not  in  itself 


LAMENESS   IN  THE  FORE  LEG  91 

an  essential  feature  to  he  considered  in  a  discussion  of  symptoms. 
Where  a  contusion  of  the  anterior  brachial  structures  occurs, 
there  is,  in  addition  to  lameness,  swelling  which  is  painful  be- 
cause of  the  pressure  occasioned  by  the  heavy  non-yielding  ])ra- 
chial  fascia.  And  where  suppuration  occurs,  there  is  then  an 
intensely  painful  condition  which  is  not  relieved  until  pus  has 
been  evacuated.  Rather  frequently,  drainage  for  wound  secre- 
tions is  a  difficult  problem,  and  approximation  of  the  divided 
ends  of  muscles  is  always  difficult  to  maintain. 

Treatment. — Contused  wounds  of  the  anterior  brachial  region 
are  treated  along  usual  lines ;  that  is,  attempt  is  made  to  stimu- 
late prompt  resolution.  Hot  or  cold  applications  are  employed 
throughout  the  acute  stage  of  the  affection.  Complete  rest  is 
provided  for  until  all  pain  has  subsided.  Later,  stimulating  lini- 
ments are  beneficial. 

Where  no  injury  is  done  the  periosteum  or  bone,  complete 
resorption  of  all  products  of  inflammation  usually  occurs,  though 
in  many  instances,  this  is  tardy — six  weeks  or  more  are  some- 
times required  for  recovery  to  take  plac'?. 

If  suppuration  occurs,  it  is  necessary  to  provide  for  drainage 
as  soon  as  it  is  possil)le  to  distinguish  the  presence  of  pus.  Due 
regard  is  given  the  manner  of  establishing  drainage  because  of 
the  usual  existence  of  su])-fascial  fistulae.  In  these  cases,  one 
avoids  injecting  solutions  of  aqueous  antiseptics.  By  gently  com- 
pressing the  parts,  pus  is  caused  to  drain  out  and  in  enforeinsr 
a  moderate  amount  of  exercise  at  a  walk,  when  lameness  is  not 
intense,  drainage  is  maintained.  Cotton  packs,  moistened  with 
hot  antiseptic  solutions,  and  kept  around  the  forearm  for  sev- 
eral hours  daily,  are  helpful  because  drainage  is  facilitated, 
and  resolution  is  stimulated  by  the  increase  of  blood  thus  at- 
tracted to  the  parts,  and  pain  materially  diminishes. 

In  lacerated  wounds  of  the  anterior  brachial  region,  after 
having  controlled  hemorrhage,  an  area  around  the  wound  margin 
is  freed  of  hair  by  clipping  or  shaving.  The  wound  is  carefully 
examined,  and  the  best  site  for  drainage  is  selected  and  a  suit- 
able opening  for  wound  discharge  is  provided  for.  Where  the 
extensor  carpiradialis  (metacarpi  magnus)  with  other  struc- 
tures, is  divided  and  the  distal  portion  is  torn  downward,  as 


92  LAMENESS  OF  THE  HORSE 

frequently  is  the  case  in  barbed  wire  cuts,  it  is  necessary  to 
make  careful  provision  for  drainage.  The  wound  is  thoroughly 
cleansed  by  means  of  ablutions  if  necess;iry;  but  preferably  l)y 
swabbing  with  pledgets  of  cotton  or  gauze  which  are  moistened 
in  antiseptic  solutions.  All  shreds  of  macerated  tissue  are 
clipped  with  scissors  and  finally  the  whole  wound  surface  is 
painted  with  tincture  of  iodin. 

If  drainage  is  made  by  cutting  through  the  tissues  in  the 
median  portion  of  the  structures  that  have  been  displaced,  the 
opening  should  be  packed  with  gauze  so  that  it  may  remain 
patent  after  swelling  has  occurred.  Such  packing  is  left  in 
situ  for  twenty-four  hours. 

The  pendant  muscular  portions  of  tissues  are  sutured  up  by 
means  of  tapes  and,  while  perfect  apposition  is  not  ordinarily 
possible,  it  is  very  essential  to  train  the  pendant  tissues  in  their 
normal  position  even  if  they  require  resuturiug  within  a  week. 
This  minimizes  granulation  of  tissue,  and  there  results  less  scar 
if  the  detached  portions  are  kept  near,  even  if  not  in  contact  with 
the  proximal  wound  margins.  The  skin  together  with  sub- 
cutaneous fascia  is  sutured  on  either  side  unless  drainage  is  to 
be  provided  for  on  one  side,  and  the  lowermost  part  of  that  side 
is  left  unsutured. 

After-care. — Where  extensive  suturing  of  tissues  has  been 
necessary,  subjects  must  be  kept  quiet.  They  are  best  confined 
in  box  stalls  and  not  taken  out  for  several  weeks.  Particularly 
is  this  true  where  transverse  division  of  extensors  has  taken  place. 
Sutures  are  removed  at  the  end  of  from  ten  days  to  three  weeks 
as  cases  permit.  Drainage  of  wound  secretions,  which  usually 
become  infected,  is  necessary,  because  M'ith  obstructed  drainage 
in  an  infected  wound  of  this  kind,  there  will  result  an  early 
destruction  of  tissue  at  some  point  sutured.  Daily  irrigation 
done  in  a  manner  that  practical  asepsis  is  carried  out,  is  neces- 
sary for  about  a  week.  All  irrigation  is  done  by  way  of  the 
drainage  opening,  and  this  with  warm  aqueous  solutions  of  suit- 
able antiseptics.  After  a  week  or  ten  days'  time,  the  wound 
should  not  be  dressed  more  frequently  than  twice  weekly. 

If  it  is  necessary  to  leave  a  portion  of  the  wound  uncovered. 


LAMENESS  IN  THE  FORE  LEG  93 

as  in  cases  where  skin  is  destroyed,  the  frequent  (three  or  four 
daily)  application  of  a  suitable  antiseptic  powder  is  necessary 
to  check  exuberant  granulation.  This  may  be  directly  effected 
by  the  use  of  an  astringent  or  desiccant  preparation,  and  such 
dressing  serves  as  a  mechanical  protection  as  well. 

When  such  wounds  are  kept  clean,  where  drainage  is  properly 
maintained,  and  the  subject  kept  quiet,  no  particular  attention 
other  than  the  local  application  of  an  astringent  lotion  (such 
as  the  zinc  and  lead  lotion)  is  necessary  after  the  first  three  or 
four  weeks.  Usually,  if  the  animal  gnaws  at  the  parts  or  other- 
wise manifests  evidence  of  discomfort,  it  is  an  indication  that 
new  areas  of  infection  are  being  established  because  of  obstructed 
drainage  or  retained  eschars.  A  thorough  cleansing  of  the 
wound  with  a  two  per  cent  solution  of  Liquor  Cresolis  Com- 
positus  and  this  followed  by  moistening  every  part  of  the  wound 
with  tincture  of  iodin,  will  check  all  such  disturbance  if  done 
promptly. 

Where  practically  all  of  the  anterior  surface  of  the  radius 
has  been  denuded,  recovery  is  tardy  and  there  is  in  some  cases 
imperfect  extension  of  the  leg  for  months  after  the  wound  has 
healed.  But  in  such  instances,  animals  gradually  regain  com- 
plete use  of  the  affected  member  and  in  the  course  of  a  year 
function  is  fully  restored. 

Inflammation  and  Contraction  of  the  Carpal  Flexors. 

Anatomy. — The  structures  w^hich  are  usually  considered  as 
true  flexors  of  the  carpus  are  a  group  of  three  muscles,  which 
have  separate  heads  of  origin  and  different  points  of  tendinous 
insertion. 

The  flexor  carpiradialis  (flexor  metacarpi  internus)  originates 
from  the  medial  epicondyle  of  the  humerus.  It  is  inserted  to 
the  proximal  end  of  the  medial  metacarpal  (inner  metacarpal  or 
splint)  bone.  This  muscle  is  the  smaller  of  the  three  and  is  not 
usually  divided  in  doing  carpal  tenotomy. 

The  flexor  carpiulnaris  (flexor  metacarpi  medius)  has  two 
heads  of  origin ;  one,  the  larger,  originates  from  the  epicondyle 
of  the  humerus  and  the  other  from  the  posterior  surface  of  the 


94  LAMENESS  OF  THE  HORSE 

oleenmon.  The  two  heads  unite  at  the  upper  third  of  the  radius 
and  the  muscle,  becoming  tendinous,  as  is  the  case  with  the  other 
carpal  flexors,  is  attached  by  one  point  of  insertion  to  the  acces- 
sory carpal  bone  (trapezum).  The  other  blends  with  the 
posterior  annular  ligament  of  the  carpus. 

The  ulnaris  lateralis  (flexor  metacarpi  externus)  has  its  origin 
from  the  lateral  epicondyle  of  the  humerus  and  inserts  to  the 
proximal  extremity  of  the  fourth  metacarpal  (outer  splint) 
bone  and  by  another  attachment  to  the  accessory  carpal  bone 
(trapezium)  with  the  tendon  of  the  flexor  carpiulnaris  (flexor 
metacarpi  medius). 

Acting  together,  these  muscles  flex  the  carpus  or  extend  the 
elbow  and  this  action  is  antagonized  by  the  biceps  brachii  (flexor 
brachii)   and  extensors  of  the  carpus  and  phalanges. 

Etiology  and  Occurrence. — Inflammation  of  the  muscular  or 
tendinous  parts  of  tlie  carpal  flexors,  does  not  occur  as  fre- 
quently as  does  inflammation  of  the  flexors  of  the  extremity. 
They  are  subject  to  injury  such  as  is  occasioned  by  hard  work 
and  concussion  and  contract  as  a  result ;  but,  more  frecjuently 
a  congenital  malformation  of  the  leg  is  responsible  for  undue 
strain  upon  these  parts.  Horses  that  are  "knee  sprung"  or  that 
have  a  congenital  condition  where  in  the  anterior  line,  as  formed 
by  the  radius,  carpal  and  metacarpal  bones,  is  bent  forward  at 
the  carpus,  are  subject  to  inflammation  and  contraction  of  the 
carpal  flexors.  When  these  flexors  are  contracted,  the  condition 
is  commonly  known  among  horsemen  as  "buck  knee."  In  itself, 
intlaiiimation  of  the  carpal  flexors  is  not  a  condition  which  is 
likely  to  prove  troulilesome,  l)ut  because  of  carpal  involvement 
(which  is  often  present)  the  cause  of  the  troul)le  remains,  and 
inHaiinnation  of  the  carpal  flexors  recurs  or  becomes  chronic 
and  contraction  of  tendons  results. 

Symptomatolog-y. — Inflammation  of  the  carpal  flexors,  when 
acute  and  uiici»iii|)licated,  is  characterized  ]\v  a  painfully  swollen 
condition  of  the  afl'cctcd  tendons.  No  weight  is  ])orne  upon 
the  affected  leg  and  tlic  carpal  joint  is  flexed.  .Mixed  huneness 
is  present.  There  is  no  difficidty  encountered  in  arriving  at  a 
diagnosis  because  of  Ihe  very  noticeably  inHamed  parts. 


LAMENESS   IN  THE  FORE   LEG 


05 


IMaiiy  fully  developed  cases  of  eoiitraction  of  the  tendons  of 
the  carpal  flexors  are  observed  where  the  condition  has  become 
established  gradually  and  no  lameness  has  resulted  from  tendin- 
itis or  carpitis.  In  some  of  these  cases,  subjects  are  stumblers 
and  when  they  are  carelessly  handled  or  kept  at  fast  work  over 
irregular  or  hard  roads,  chronic  carpitis  with  hyperplasia  of  the 
structures  of  the  anterior  carpal  region  results,  owing  to  frequent 
bruising  from  falls. 


Fig.    10 — Contraction    of    carpal    flexors,    "knee    sprung." 

Where  inflammation  is  caused  by  a  puncture  wound  and  sub- 
fascial infection  occurs,  there  is  evident  manifestation  of  pain. 
No  weight  is  supported  liy  the  affected  member  and  because  of 
the  pressure,  occasioned  by  the  swollen  muscles  confined  within 
the  non-yielding  brachial  fascia,  there  exists  marked  supersensi- 
tiveness  of  the  affected  parts.  Flexion  of  the  elliow  is  avoided 
because  contraction  of  the  biceps  l)rachii  (flexor  l)rachii)  or  the 
extensors,  which  are  antagonists  of  the  flexors  of  the  carpus, 
tenses  the  carpal  flexors  and  pain  is  thereby  increased. 

However,  in  most  instances,  the  practitioner's  attention  is  not 
directed  to  typical  and  uncomplicated  cases,  but  to  subacute  or 
chronic  inHainmations  which  are  often  attended  with  contraction 
of  the  tendinous  pai'ts  of  the  carpal  fiexors,  and  in  such  cases 


96  LAMENESS  OF  THE  HORSE 

carpitis  is  present.  Animals  so  affected  have  lost  the  rigidity 
Avhich  characterizes  the  normal  carpal  joint  when  the  leg  is  a 
weight  bearing  member,  and  because  of  its  sprung  condition, 
the  leg  trembles  when  supporting  weight. 

Treatment. — Acute  inflammation  is  treated  by  means  of  local 
application  of  cold  or  hot  packs  until  the  pain  and  acute  stage 
of  inflammation  has  subsided  and  later  stimulating  liniments 
are  indicated.  Absolute  quiet  must  be  enforced.  Especially 
where  the  carpus  is  involved  must  the  subject  be  kept  quiet  until 
all  evidence  of  inflammation  has  subsided. 

The  application  of  vesicants  or  line-firing  is  beneficial  in  sub- 
acute inflammation  of  the  tendons  of  the  carpal  flexors.  Where 
contraction  of  tendons  exists  and  no  osseous  or  ligamentous 
change  prevents  correction  of  the  condition,  tenotomy  is  neces- 
sary. The  reader  is  referred  to  Merillat's  "Veterinary  Surgery"^ 
for  a  good  description  of  the  technic  of  this  operation. 

In  all  serious  cases  of  inflammation  of  the  carpal  flexors, 
whether  tenotomy  has  been  performed  or  not,  the  subject  needs 
a  long  period  of  rest  subsequent  to  treatment.  In  fact,  three 
or  four  months  at  pasture  is  necessary  to  permit  of  recovery 
and  this  where  no  congenital  deformity  has  predisposed  the  sub- 
ject to  such  affection  of  the  flexors.  Return  to  work  must  be 
gradual  and  the  character  of  the  work  such  as  to  enable  the 
animal  to  become  inured  to  service  without  a  recurrence  of  the 
trouble  if  possible. 

It  follows  then,  that  tenotomy,  here  as  in  other  cases,  is  not 
practical  from  an  economic  viewpoint,  unless  the  animal  be  of 
sufficient  value  to  justify  the  long  period  of  rest  for  recovery. 
Tenotomy  is  not  of  practical  benefit  unless  ample  time  is  allowed 
for  regeneration  of  divided  tendinous  tissue. 

Fracture  and  Luxation  of  the  CarpaJ  Bones. 

Etiolog-y  and  Occurrence. — Fracture  of  the  carpal  bones  is  of 
infrequent  occurrence  in  horses  and,  wlien  it  does  occur,  it  is 
usually  due  to  injuries,  and  because  of  their  nature  (resulting 
as  they  generally  do  from  heavy  falls  or  in  being  run  over  by 

""^Veterinary  Surgical  Operations,  by  L.  A.  Merillat,  Vol.  3,  p.  19S. 


LAMENESS   IN  THE  FORE  LEG  97 

street  ears  or  wagons),  a  comminuted  fracture  of  one  or  more 
bones  exists.  The  accessory  carpal  bone  (trapezium)  is  said  to 
be  fractured  at  times  without  being  subjected  to  blows  or  like 
injuries,  but  this  is  exceptional. 

Luxations  of  the  carpal  joint  are  of  rare  occurrence,  and  very 
few  cases  of  this  kind  are  on  record.  Walters^  reports  a  case 
of  carpometacarpal  luxation  in  a  pony  wherein  reduction  was 
spontaneous  and  an  uneventful  recovery  followed.  His  reason 
for  reporting  the  case,  as  he  states,  is  its  rarity. 

Symptomatology. — Fractures  of  the  carpal  bones  as  they 
usually  take  place  are  diagnosed  without  difficulty.  Because 
of  their  usually  being  comminuted,  abnormal  movement  of  the 
joint  is  possible.  Such  movement  is  not  restricted  and  flexion 
of  the  leg  at  the  carpus  in  any  direction  is  possible.  Crepitation 
is  readily  detected  and  frequently  these  fractures  are  of  the 
compound-comminuted  variety. 

In  fracture  of  the  accessory  carpal  bone  (trapezium)  or  in 
fracture  of  any  other  single  bone  when  such  exists,  there  is  no 
increase  in  the  movement  of  the  joint.  The  accessory  carpal 
bone  may  be  readily  manipulated  and  when  fractured,  its  parts 
are  more  or  less  displaced.  Recognition  of  fracture  of  any  other 
single  carpal  bone  must  be  done  by  detecting  crepitation  unless 
it  be  a  compound  fracture,  whereupon  probing  is  of  aid  in  es- 
tablishing a  diagnosis. 

Carpal  luxation  when  present  is  to  be  recognized  by  finding 
the  apposing  carpal  bones  joined  in  an  abnormal  manner — that 
is,  out  of  position.  There  is  restricted  or  suspended  function 
of  the  joint,  and  in  the  cases  recorded,  no  difficulty  has  been 
experienced  in  making  a  diagnosis.  The  carpometacarpal  por- 
tion of  the  articulation  is  the  part  which  is  usually  affected. 

Prognosis  and  Treatment. — There  is  no  chance  for  complete 
recovery  in  the  usual  case  of  carpal  fracture  because  of  the  fact 
that  there  results  sufficient  arthritis  to  destroy  articular  cartilage 
beyond  repair.  In  the  average  instance,  because  of  arthritis 
which  persists  for  a  considerable  length  of  time,  more  or  less 
ankylosis  results.     At  best,  one  can  only  hope  for  partial  re- 


iWilfred  Walters,  American  Journal  of  Veterinary  Medicine,  Vol.  8,  p.  606. 


98  LAMENESS  OF  THE  HORSE 

eovery,  that  is  to  say,  the  member  may  regain  its  usefulness  as 
a  weight-supporting-  part,  but  because  of  restricted  or  abolished 
joint  function,  locomotion  is  more  or  less  difficult.  Exostoses, 
articular  and  periarticular,  occur  and  the  carpus  usually  be- 
comes a  large  immobile  articulation.  There  is  danger  of  infec- 
tion resulting  in  simple  carpal  fractures  and,  needless  to  say, 
in  a  compound- comminuted  fracture  of  the  carpus,  infection 
usually  occurs  and  a  fatal  outcome  is  probable. 

When  treatment  is  instituted,  antiseptic  precautions  are  taken 
in  handling  the  compound  fractures,  and  in  any  case  immobiliza- 
tion of  the  parts  is  sought.  Here,  as  has  been  previously  pointed 
out,  it  is  best  to  employ  leather  splints,  so  that  a  maximum  de- 
gree of  rigidity  with  a  minimum  of  distress  and  inconvenience 
to  the  patient  will  result.  The  leg  must  be  bandaged  from  the 
hoof  upward,  making  use  of  a  sufficient  amount  of  cotton  to 
ensure  against  pressure-necrosis.  The  leather  splints  are  placed 
mesially  and  laterally  and,  of  course,  need  to  extend  as  high 
as  the  proximal  end  of  the  radius.  SuL-jects  must  be  kept  in 
slings  until  union  of  bones  has  become  established,  and  as  a 
rule  there  will  then  exist  marked  ankylosis. 

There  is  no  particular  difference  in  the  handling  of  carpal 
luxation  and  dislocation  of  other  bones.  Where  ligaments  have 
not  been  destroyed  to  the  extent  that  reduction  is  of  no  prac- 
tical use,  the  parts  are  kept  immobilized,  if  thought  necessary. 
Later,  vesication  of  the  whole  pericarpal  region  is  done  and  the 
subject   allowed  exercise   at   will. 

Carpitis. 

Etiology  and  Occurrence. — Inflammation  of  the  carpus  is 
caused  by  contusions,  such  as  are  occasioned  in  falling,  by  kicks 
by  striking  the  carpus  against  objects  in  jumping  and  some- 
times by  striking  it  against  the  manger  in  pawing.  The  con- 
dition is  of  rather  frequent  occurrence. 

Symptomatology. — Evident  symptoms  of  inflammation  in 
carpitis  are  always  present — hyperthermia,  supersensitiveness 
and  swelling.  Also,  there  exists  lameness  which  is  characterized 
by  an  a])parent  inability  to   flex  the  leg,  and  there  is  eircum- 


LAMENESS   IN  THE  FORE  LEG 


99 


duction  of  the  leg  as  it  is  advanced  l)eeaase  in  this  way  littk'  if 
any  flexion  of  the  carpus  (which  increases  pain)  is  necessary. 

Depending    upon    the    nature    of   the    cause,    there    occurs   a 
marked   difference    in    the    character   and   amount    of   swelling. 


Fig.   11 Pericarpal  inflammation  and  enlargement  due  to  injurj'. 

Naturally,  when  nuich  extravasation  of  serum  and  1)lo()d  takes 
place,  there  is  occasioned  a  fluctuating  swelling  which  is  usually 
less  painful  to  the  subject  upon  manipulation  than  is  a  dense 
inflammatory  change  without  marked  extravasation. 

In  acute  carpitis,  there  is  present,  then,  a  very  painful  con- 
dition which  involves  the  articulation,  causing  marked  lameness, 
disturbance  of  appetite  and  some  elevation  of  temperature. 

Chronic  cases  do  not  occasion  serious  pain  or  constitutional 
disturbances,  but  do  interfere  with  locomotion  in  direct  propor- 
tion to  the  existing  articular  inflammation  and  periarticular 
hypertrophy  of  ligamentous  and  tendinoi^.s  structures. 

Treatment.— If  possible,  keep  the  subject  absolutely  quiet, 
employing  the  sling  if  necessary.  During  the  first  stages  of  in- 
flammation, the  ai)plication  of  ice  packs  to  the  affected  parts,  is 


100  LAMENESS  OF  THE  HORSE 

of  marked  benefit.  At  the  end  of  forty-eight  hours,  hot  applica- 
tions may  be  used  and  this  treatment  continued  throughout  sev- 
eral days.  Anodyne  liniments  are  of  service  and  should  be  em- 
ployed throughout  the  acute  stage  of  infiammation  during  in- 
tervals between  the  hydrotherapeutic  treatments. 

As  inflammation  subsides,  a  counterirritating  application  such 


Fig-.  12 — ^HygTomatous  condition  of  the  right  carpus,  also  distension  of 
sheaths  of  extensor  tendons  of  botli  fore  legs. 

as  a  suitable  liniment  and  later  blistering  or  line-firing  is  help- 
ful in  stimulating  resolution. 

Open  Carpsd  Joint. 

Anatomy. — The  carpal  bones  as  they  articulate  with  one  an- 
other and  with  the  radius  and  metacarpal  bones,  as  classed  by 
anatomists,  form  three  distinct  articular  parts  of  the  joint  as  a 
whole  and  are  known  as  radiocarpal,  intercarpal  and  carpometa- 
carpal. These  three  pairs  of  articulating  surfaces  are  all  en- 
closed within  one  capsular  ligament.  On  the  anterior  face  of  the 
bones,  the  capsular  ligament  is  attached  to  the  carpal  bones  in 


LAMENESS  IN  THE  FORE  LEG  101 

such  manner  that  an  imperfect  partitioning  of  the  three  joint 
compartments  is  formed.  Posteriorly,  the  capsule  is  very  heavy 
and  forms  a  sort  of  padding  over  the  irregular  surfaces  of  the 
bones,  and  also  its  reflexions  constitute  the  sheaths  of  the  flexor 
tendons.  The  anterior  portion  of  the  capsular  ligament  forms 
sheaths  for  the  extensor  tendons,  and  both  portions  of  the  joint 
have  an  attachment  around  the  distal  end  of  the  radius  and 
another  at  the  proximal  end  of  the  metacarpal  bones. 

Etiology  and  Opcurrence. — Puncture  wounds  of  any  kind 


Fig.  13 — Carpal  exostosis  in  aged  horse. 

may  serve  to  perforate  the  joint  capsule  and  such  traumatisms 
are  occasioned  by  falls,  kicks  and  iu  various  ways  in  runaway 
accidents,  and  open  carpal  joint  may  follow. 

Symptomatology. — The  pathognomonic  symptoms  of  the  ex- 
istence of  an  open  joint  is  the  exposure  to  view  of  articular 
surfaces  of  bones  or  noting  the  escape  of  synovia  from  the  joint 
capsule.  As  has  been  previously  referred  to,  there  always  exists 
a  peculiar  suspension  of  carpal  flexion  in  all  cases  of  carpitis. 

Non-infective  wounds  which  may  cause  open  joint  are  not 
necessarily  productive  of  an  active  carpitis — a  synovitis  may 
be  the  extent  of  the  disturbance.     Ualike  synovitis,  which  may 


102 


LAMENESS  OF  THE   HORSE 


characterize  a  non-infectious  penetrative  wound  of  the  capsular 
ligament,  septic  arthritis  which  may  supervene  is  a  very  painful 
inflammatory  disturbance.  It  is  characterized  by  all  of  the 
symptoms  which  attend  the  case  of  open  joint  and  synovitis  plu.s 
the  obvious  manifestation  of  great  pain.  There  is  an  elevation 
of  temperature  of  from  two  to  five  degrees  above  normal;  cir- 
culation is  accelerated;  the  pulse  is  bounding;  respiration  is 
hurried ;  there  is  an  expression  of  pain  as  indicated  by  the 
physiognomy;  and  because  of  rapid  erosive  changes  of  cartilages 
which  take  place,  there  is  soon  so  much  of  the  articulation  de- 
stroyed that  death  is  inevitable.  Death  is  usually  due  to  gen- 
eralization of  the  arthritic  infection. 

In  the  meanwhile,  if  the  character  of  the  infectious  material 
is   not   so  virulent,   the   disease   will   take   on   a   slower   course 

and  the  subject  may  experience 
laminitis  from  supporting  weight 
upon  the  sound  member,  or  be- 
cause of  continued  recumbency, 
decubital   gangrene    and    emacia- 


Fig.  14 — Exostosis     of 
resultant  from  carpitis. 


carpu.s 


-pig.  15 — Distal  end  of  radius.  U- 
lustrating  the  effects  of  chronic  car- 
pitis. 


LAMENESS   IN  THE  FORE  LEG  103 

tion  sometimes  cause  death.  If  the  subject  does  not  soon  suc- 
cumb, it  is  compelled  to  undergo  days  or  even  weeks  of  unneces- 
sary suffering,  and  too  often  in  such  cases,  it  is  later  deemed 
advisable  to  destroy  the  animal  because  of  the  cost  of  continuing 
treatment  until  the  horse  is  serviceable.  Therefore,  it  is  evident 
that  when  such  joints  as  the  carpus  or  tarsus  are  open  and  infec- 
tion exists,  if  they  are  not  promptly  treated  and  the  infectious 
process  checked,  it  is  neither  humane  nor  practical  to  prolong 
treatment. 

Distinction  must  be  made  between  the  different  joints  wher, 
infected  as  the  condition  is  much  more  serious  in  some  cases 
than  in  others.  All  things  considered,  perhaps  open  joints  rank, 
with  respect  to  being  serious  cases  as  follows:  elbow,  navicular, 
stifle,  tarsus,  carpus,  fetlock  and  pa.stern.  This,  of  course,  is 
restricted  to  articulations  of  the  locomotory  apparatus. 

Treatment. — Preliminary  care  in  the  treatment  of  an  open 
carpal  joint,  is  the  same  as  has  been  described  in  this  condition 
as  it  affects  the  scapulohumeral  articulation  described  on  page 
65.  Likewise  the  further  treatment  of  such  cases  is  along  the 
same  lines  except  that  where  it  is  possible,  the  parts  are  kept  cov- 
ered with  cotton  and  bandages.  However,  in  some  cases,  animals 
have  been  successfully  treated  without  bandaging  and  by  keep- 
ing the  patient  in  a  standing  position  and  on  pillar  reins  until 
recovery  resulted.  Such  cases  were  of  the  non-infectious  type 
and  recovery  was  possible  within  three  or  four  weeks.  Further, 
the  condition  is  not  sufficiently  painful  in  such  instances  as  to 
prevent  the  subjects  bearing  weight  with  the  affected  member ; 
hence,  no  danger  of  resulting  laminitis  is  incurred.  And  finally, 
where  bandages  are  not  employed,  the  frequent  use  of  antiseptic 
dusting  powders  is  substituted  for  cotton  as  a  protector. 

When  l)andaged,  such  wounds  need  dressing  more  or  less  fre- 
quently, as  individual  instances  demand.  The  purulent  infective 
inflammation  of  a  carpal  joint  will  recpiire  daily  dressing;  where- 
as, in  other  cases  (non-infective),  semi-weekly  change  of  band- 
ages is  sufficient.  E(|ual  parts  of  l)oric  acid  and  exsiccated  alum 
constitute  a  suitalile  combination  for  the  treatment  of  these 
cases,  and  this  powder  should  be  liberally  employed.  Tincture 
of  iodin  may  be  injected  into  the  joint  capsule  where  there  is 


104  LAMENESS  OF  THE  HORSE 

provision  for  its  ready  evacuation,  as  conditions  seem  to  require. 
Daily  injections  for  three,  four  or  five  days,  are  not  harmful 
and  will  control  infection  in  many  instances. 

Thecltis  and  Bursitis. 

Etiology  and  Occurrence. — The  thecae  and  bursae  of  the  leg 
are  several  in  number.  In  the  carpal  region,  the  flexors  of  the 
phalanges  are  contained  together  in  the  carpal  sheath,  and  this 
is  the  principal  theca  in  the  carpal  region.  Each  of  the  tendons 
is  provided  with  synovial  sheaths  which  are  subject  to  inflam- 
mation and  occasionally  synovitis  and  distension  of  these  synovial 
sheaths  occur. 

Because  of  faulty  conformation,  some  animals  are  subject  to 
inflammation  of  these  sheaths,  and  all  forms  of  strenuous  work 
which  taxes  the  tendons  greatly  is  apt  to  result  in  synovitis. 
Direct  injury  such  as  blows  may  be  the  cause  of  synovial  disten- 
sion of  thecae  and  the  affection  is  to  be  seen  in  all  horses  that 
have  done  much  fast  work  on  hard  road  surfaces  or  pavements. 

The  usual  case  as  it  occurs  in  practice  is  a  non-infective  syn- 
ovitis, but  where  puncture  wounds  cause  the  trouble,  an  in- 
fectious inflammation  obtains. 

Symptomatology. — No  trouble  is  experienced  in  diagnosing 
distension  of  tendon  sheaths,  for  the  affection  is  very  palpable. 
During  acute  inflammatory  stages  of  this  affection,  some  lame- 
ness is  present — in  infectious  inflammation  lameness  is  intense. 
Local  heat  and  pain  upon  manipulation  are  readily  discernible 
in  all  acute  cases.  And  finally,  where  there  is  reason  for  doubt, 
an  aseptic  exploratory  puncture  of  the  wall  of  the  fluctuating 
enlargement  may  be  made  with  a  suitable  trocar,  and  the  dis- 
charging synovia  will  be  proof  of  the  existence  of  synovial  dis- 
tension. 

After  the  affection  becomes  subacute  or  chronic,  no  lameness 
or  inconvenience  is  manifested,  and  the  condition  is  undesirable 
only  because  of  its  being  a  blemish. 

Treatment. — Acute  non-infectious  synovial  distension  of  ten- 
don sheaths  is  treated  by  aspirating  as  much  synovia  as  pos- 
sible from  the  affected  theca    (this  is,   of  course,   done  under 


LAMENESS  IN  THE  FORE  LEG  105 

strict  asepsis)  and  by  means  of  bandages,  a  uniform  degree  of 
pressure  is  kept  over  the  parts  for  ten  days  or  two  weeks.  The 
patient  is  kept  quiet  and  in  the  course  of  two  weeks  an  active 
blistering  agent  is  employed  over  the  region  affected.  Usually, 
at  the  end  of  a  month's  time,  complete  recovery  has  taken  place 
and  the  subject  may  be  gradually  returned  to  work. 

When  synovial  distensions  are  of  long  standing,  it  is  necessary 
to  take  special  precautions  to  cheek  excessive  secretion  of  synovial 
fluid,  and,  also  because  of  the  atonic  condition  of  the  tissues 
affected,  resolution  is  tardy.  In  addition  to  aspirating  synovia, 
the  introduction  of  equal  parts  of  alcohol  and  tincture  of  iodin 
into  the  theca  is  necessary.  The  quantity  of  this  combination 
injected,  depends  upon  the  size  of  the  sheath  affected  and  the 
amount  of  synovia  retained  at  the  time  injection  is  made.  Ex- 
perience is  necessary  to  judge  as  to  this  part  of  the  work,  but 
one  may  consider  that  a  quantity  between  three  and  ten  cubic 
centimeters  of  equal  parts  of  tincture  of  iodin  and  alcohol  con- 
stitutes the  proper  amount  to  employ.  Where  much  synovia  is 
contained  within  the  sheath  at  the  time  of  injection,  there  occurs 
great  dilution  of  the  agent  injected  and  consequently  less  irri- 
tation results. 

The  object  of  such  injections  is  to  check  synovial  secretion, 
and  this  is  sought  by  the  local  effect  of  iodin  in  contact  with  the 
secreting  cells  together  with  the  reactionary  swelling  which  oc- 
casions pressure.  An  increase  in  the  local  blood  supply  also 
follows.  In  all  cases  where  it  is  possible  to  employ  suitable 
bandages,  this  should  be  done.  The  ordinary  derby  bandages 
serve  well  and  if  their  use  is  continued  for  a  sufficient  length  of 
time,  good  results  follow. 

There  are  other  methods  of  treating  these  affections,  and  each 
has  its  advantages  and  disadvantages.  Line-firing,  instead  of 
the  vesicant  is  made  use  of  by  some,  but  the  object  desired  is 
the  same  and  results  obtained  are  similar. 

Sheaths  may  be  opened  surgically  by  means  of  a  knife,  and 
the  removal  of  a  portion  of  the  wall  of  distended  and  atonic 
tendon  sheaths  is  possible.  These  operations  belong  to  the  realm 
of  surgery  and  are  not  properly  a  part  of  this  treatise.  However, 
in  passing,  it  may  be  said  that  if  a  perfect  technic  is  possible  in 


106  LAMENESS  OF  THE   HORSE 

doing  the  last  iiained   operation,  a   permanent  recovery  is  the 
ontcome. 

Fracture  of  the  Metacarpus. 

Etiology  and  Occurrence. — As  the  resnit  of  all  sorts  of  vio- 
lence, such  as  falls  and  injuries  in  accidents  of  various  kinds 
wherein  the  metacarpals  are  subjected  to  contusions,  fractures 
may  result.  In  the  horse  it  is  unusual  for  fracture  of  one  of  the 
small  metacarpal  bones  to  take  place  without  there  being  at  the 
same  time  a  fracture  of  the  third  (large)  metacarpal  lione. 

Classification. — Fractures  of  the  metacarpal  bones  as  they 
occur,  are  as  likely  to  be  compound  as  simple,  and  the  nudtiple 
and  comminuted  varieties  are  -occasionally  observed.  The  man- 
ner in  which  the  third  (large)  metacarpus  is  fractured,  largely 
determines  the  outcome  in  any  given  case. 

Symptomatology. — Abnormal  mobility  of  the  l)roken  parts 
of  bone  and  crepitation  mark  fracture  cf  the  metacarpus,  and 
the  condition  is  easily  diagnosed.  In  many  instances,  when 
compound  fracture  exists,  broken  ends  of  bone  are  protruding 
through  the  skin.  No  weight  is  borne  upon  the  fractured  mem- 
ber ordinarily,  altliough  during  the  excitement  occasioned  by 
runaways,  horses  are  sometimes  seen  to  support  weight  with  a 
broken  leg  even  when  the  protruding  bone  is  sunk  into  the 
ground  in  so  doing. 

Prognosis. — Generally  speaking,  fractures  other  than  the 
simple-transverse  in  young  animals,  are  considered  unfavorable 
eases.  With  the  metacarpus,  however,  there  are  instances  where 
compound  fracture  occurs  in  colts  that  justify  treatment.  But 
in  all  cases  of  compound  fracture,  the  element  of  infection  in 
addition  to  the  increased  difficulty  in  maintaining  immoliility 
of  the  broken  bone,  creates  almost  insuperable  difficulties  in  the 
average  instance.  And  unless  the  practitioner  distinctly  ex- 
plains to  his  client  the  various  reasons  wliich  make  treatment  an 
economic  imin'acticability,  dissatisfaction  is  likely  to  follow  if 
treatment   is  instituted  without  such  an  underetanding. 

Treatment. — Perfect  ai)i)()sition  of  tiie  broken  ends  of  bone 
is  easily  effected  and  less  difficulty  is  encountered  in  maintain- 


LAMENESS   IN  THE  FORE  LEG  107 

ing  such  relations  in  metacarpal  fractures  than  in  fractures  of 
the  radius.  However,  reduction  and  immobilization  of  this  as 
in  all  fractures,  must  be  done  without  delay.  In  simple  fracture, 
the  metacarinis  is  covered  with  enough  cotton  to  pad  the  parts, 
and  this  is  retained  in  position  by  liandages.  Splints  of  heavy 
leather  or  of  thin  pieces  of  tough  flexible  wood  are  placed  on 
each  side  of  the  leg  and  firmly  held  in  position  with  bandages. 
Bandages  may  be  put  on  in  layers  and  a  coating  of  glue  ap- 
plied over  each  layer  if  this  is  thought  necessary.  The  ad- 
vantage gained  in  using  glue  or  other  adhesive  materials  is  that 
the  cast  thus  formed  is  more  rigid  than  where  such  material  is 
not  employed.  On  the  other  hand,  all  elasticity  is  lost  as  soon 
as  the  cast  adapts  itself  to  the  contour  of  the  extremity,  and 
because  of  this  rigidity,  it  is  doubtful  if  anything  is  gained  by 
the  incorporation  of  glue,  except  in  the  way  of  added  strength  of 
the  cast.  Since  the  animal  does  not  walk  upon  the  broken  leg, 
it  is  possible  to  employ  splints  of  suitable  materials  which  are 
retained  in  position  without  glue  and  frequent  readjustment  of 
a  part  of  the  immobilizing  apparatus  is  possible.  This  is  im- 
possible with  casts. 

In  compound  fractures,  provision  ought  to  be  nuide  for  dress- 
ing the  wound  of  the  soft  structures.  This  entails  adjusting 
the  splints  in  such  manner  that  one  splint  may  be  retained  and 
others  removed  for  dressing  the  wound  and  readjusted  as  often 
as  wound  dressing  is  necessary. 

Splints. 

By  this  term  is  meant  a  condition  where  there  exists  an 
exostosis  which  involves  usually  the  second  (inner  small)  and 
third  (large)  metacarpal  bones.  While  an  exostosis  involving 
any  one  of  the  splint  bones,  even  when  directly  caused  by  an 
injury,  is  called  a  "splint,"  the  term  is  employed  here,  in  refer- 
ence to  exostoses  not  due  to  direct  injury  such  as  in  contusions. 

Etiology  and  Occurrence. — Tliis  condition  is  one  wherein 
there  is  osseous  formation  following  a  periostitis  and  the  region 
of  the  upper  portion  of  the  second  (inner  small)  metacarpal  bone 
is  the  usual  site  of  the  exo.stosis.     There  is  incited  an  intlamma- 


108  LAMENESS  OF  THE  HORSE 

tion  of  the  periosteum  at  the  site  of  the  interosseous  ligament 
which  attaches  the  small  to  the  large  metacarpal  bone.  This  liga- 
ment is  involved  in  the  inflammatory  process,  and  according  to 
Havemann,  whose  view  is  supported  by  Moller,  this  inflamma- 
tion is  the  origin  of  the  trouble. 

Various  theories  attempting  an  explanation  of  the  frequent 
affection  of  this  one  certain  part  so  regularly  involved  have  been 
offered,  but  no  proof  of  the  correctness  of  any  exists.  It  fol- 
lows, however,  that  splints  occur  in  young  animals;  that  the 
affection  seldom  starts  in  subjects  that  are  ten  years  of  age  or 


""-■'-isliC  J- 


Fig'.  16 — Posterior  view  of  radius    (rigiit)    illustrative   of  effects   of  splint. 
Note  the  extent  of  exostosis. 

older,  and  that  when  the  exostosis  has  formed,  lameness  usually 
subsides.  Anything  which  will  cause  undue  strain  or  irritation 
of  the  metacarpal  bones  in  young  animals,  is  quite  apt  to  result 
in  a  splint  being  formed.  Concussion  such  as  is  caused  by  fast 
work  on  hard  roads,  or  work  on  rough  or  irregular  road  surfaces 
which  cause  unequal  distribution  of  weight,  will  cause  splint 
lameness  and  exostosis  follows. 

Course. — Because  of  the  peculiar  manner  in  which  the  second 
and  third  metacarpal  bones  articulate  in  j^oung  animals,  until 
the  bones  become  ossified  and  permanently  joined,  the  inflam- 
mation which  attends  the  acute  stage  of  this  affection,  causes 
lameness.  Later,  unless  an  unusually  large  exostosis  is  formed, 
whicli  may  cause  a  constant  irritation  due  to  its  size  and  juxta- 
position to  the  carpus,  lameness  is  disconlinued. 


LAMENESS  IN  THE  FORE  LEG  109 

Symptomatolog'y. — Lameness  is  usually  the  first  manifesta- 
tion of  this  disorder,  and  the  thing  which  characterizes  splint 
lameness  is  its  peculiar  intermittence.  There  is  a  mixed  form  of 
lameness  which  may  not  be  in  evidence  when  an  affected  animal 
is  started  on  a  drive,  but  which  is  marked  after  the  subject  has 
gone  some  distance.  The  animal  may,  however,  go  lame  through- 
out the  whole  of  a  drive  and  continue  to  be  lame  for  several 
days  or  weeks  in  some  cases.  It  is  noticeable  that  lameness  is 
augmented  or  produced  when  the  sul)ject  travels  on  rough  road 
surfaces  and  that  little  or  no  difficulty  is  encountered  when  roads 
are  smooth. 

The  heavy  brachial  fascia  is  inserted  in  part  to  the  head  of 
the  second  metacarpal  (inner  small)  bone  together  with  the 
oblique  digital  extensor  (extensor  metacarpi  obliquus)  and  this 
explains  the  reason  for  pain  being  manifested  during  extension 
of  the  member. 

Before  there  is  a  visible  exostosis,  supersensitiveness  is  readily 
recognized  upon  palpation  of  the  parts,  if  careful  comparison  is 
made  between  the  sound  and  unsound  members.  However,  fre- 
quently splints  occur  on  both  forelegs  at  the  same  time  and  in 
some  instances  exostoses  are  several  in  n amber  upon  each  mem- 
ber affected.  In  some  instances,  the  affection  involves  the  outer 
splint  bone  and  no  evident  involvement  of  the  inner  one  exists. 

Treatment. — At  the  onset  complete  rest  should  be  provided 
and  the  local  application  of  some  good  cataplasm  is  in  order.  A 
stimulating  liniment  is  beneficial  when  employed  several  times 
daily  and  massage  is  also  quite  helpful.  Later,  the  application 
of  a  blistering  ointment  is  good  treatment.  The  use  of  the  actual 
cautery  stimulates  prompt  resolution,  but  there  is  seldom  any 
resorption  of  products  of  inflammation  following  firing.  Where- 
as, in  cases  where  other  treatment  is  begun  early,  there  usually 
follows  considerable  diminution  in  the  size  of  the  exostosis.  A 
rest  of  four  or  five  weeks  is  necessary  and  very  young  animals 
should  not  be  put  to  work  too  soon,  if  the  character  of  the  work 
is  such  as  to  induce  a  recurrence  of  the  trouble. 

Many  cases  are  treated  successfully  in  draft  types  of  animals 
(where  the  subjects  are  not  kept  at  work  that  occasions  seri- 


110  LAMENESS  OP  THE  HORSE 

ous  irritation  to  the  aifected  parts)  by  blistering  the  exostosis 
repeatedly  and  allowing  the  animals  to  continue  in  service.  In 
such  cases,  it  is  unreasonal)le  to  expect  to  check  the  size  of  the 
exostosis  and,  of  course,  such  methods  are  not  employed  where 
lameness  causes  distress  to  the  subject. 

Firing  usually  causes  prompt  recovery  from  lameness  and  is 
a  dependable  manner  of  treating  such  eases  but  there  remains 
more  blemish  following  cauterization  than  where  vesication  is 
done. 

OPEN  FETLOCK  JOINT. 

This  condition,  because  of  the  frequency  with  which  it  occurs 
may  be  taken  as  typal,  from  the  standpoint  of  treatment  and 
results  obtained  therefrom.  AVhile  it  serves  to  constitute  a  basis 
from  which  other  joints,  when  open,  are  to  be  considered,  due 
allowance  must  be  made  for  the  fact  that,  as  has  been  previously 
mentioned,  some  articulations  when  open  constitute  cause  for 
grave  consequences;  while  with  others  an  open  capsule,  even 
when  infected,  does  not  cause  disturbance  enough  to  be  classed 
as  difficult  to  handle.  IMoreover,  the  fetlock  joint  is  admirably 
suited,  anatomically,  to  bandaging  ;  and  wdien  wounded,  is  easily 
kept  protected  by  means  of  surgical  dressings.  This  fact  is  of 
great  importance  in  influencing  the  course  and  termination  in 
any  given  case  of  open  fetlock  joint  and  should  not  be  forgotten. 

There  is  no  logical  reason  for  comparing  the  pedal  joint  with 
the  pastern  on  the  basis  that  it  may  also  be  completely  and  se- 
curely bandaged.  Open  navicular  joint  does  not  occur,  as  a 
rule,  except  by  way  of  the  solar  surface  of  the  foot,  and  the  in- 
troduction of  active  and  virulent  contagium  is  certain  to  happen; 
consequently,  an  acute  synovitis  quickly  rosidting  in  an  intensely 
septic  and  progressively  destructive  arthritis  soon  follows  in 
perforation  of  the  capsule  of  the  distal  inlerphalangeal  articula- 
tion. 

Etiology  and  Occurrence. — Wounds  of  the  fetlock  region  re- 
sulting in  perforation  or  destruction  of  a  part  of  the  capsular 
ligament  are  caused  by  all  sorts  of  accidents,  such  as  wire  cuts, 
incised  wounds  occasioned  l)y  plowshares,  disc  harrows,  stalk 
cutters  and  other  farming  implements.  In  runaways  the  joint 


LAMENESS   IN  THE  FORE  LEG  111 

capsule  is  sometimes  punctured  l)y  sliarp  pieces  of  wood  or  other 
objects.  In  horses  driven  on  un paved  country  roads  the  fetlock 
is  occasionally  wounded  by  being  struck  against  the  sharp  end 
of  some  object,  the  other  end  of  which  is  firmly  embedded  in  the 
ground.  In  one  instance  the  author  treated  a  case  wherein  the 
fetlock  joint  was  perforated  by  the  sickle-guard  of  a  self-binder. 
In  this  case  there  occurred  complete  perforation  causing  two 
openings  through  the  cul-de-sac  of  the  joint.  Such  wounds  are 
produced  l)y  implements  which  are,  to  say  the  least,  non-sterile, 
and  this  perforation  of  the  uncleansed  skin  conveys  infectious 
nuiterial  into  the  joint  capsule.  Yet  in  many  instances,  espe- 
cially in  country  practice,  no  infectious  arthritis  results  where 
cases  are  promptly  cared  for. 

Symptomatology. — A  difiPerence  in  the  character  of  symp- 
toms is  evidenced  when  dissimilar  causes  exist.  Small  penetrant 
wounds  which  infect  the  synovial  membranes  cause  infectious 
arthritis  in  some  cases,  whereas  a  wound  of  sufficient  size  to 
produce  evacuation  of  all  synovia  will,  in  many  instances,  cause 
no  serious  distress  to  the  subject,  even  wlien  not  treated  for  sev- 
eral days.  If  it  is  not  evident  that  an  open  joint  exists  and  the 
articular  cavity  is  not  exposed  to  view  a  positive  diagnosis  may 
be  early  established  by  carefully  probing  the  wound.  In  some 
cases  where  a  small  wound  has  perforated  the  joint  capsule, 
swelling  and  slight  change  of  relation  of  the  overlying  tissues 
may  preclude  all  successful  exploratory  probing.  In  such  in- 
stances it  is  necessary  to  await  development  of  symptoms. 
Twenty-four  hours  after  injury  has  been  inflicted,  there  is  notice- 
al)le  discharge  of  synovia  which  coagulates  about  the  margin  of 
the  orifice,  where  synovial  discharge  is  possible.  Particularly 
evident  is  this  accumulation  of  coagulated  synovia  where  wounds 
have  been  bandaged — there  is  no  mistaking  the  characteristic 
straw-colored  coagulum  vdiich,  in  such  cases,  is  somewhat  ten- 
acious. 

No  diflPerence  exists  between  otlicr  symi)t()ins  in  infectious 
arthritis  caused  l)y  punctures,  and  non-infectious  arthritis,  ex- 
cepting the  intensity  of  the  pain  occasioned,  the  rise  in  tempera- 
ture, circulatory  disturbances,  etc.;  all  of  which  have  been  pre- 
viously mentioned, 


112  LAMENESS  OF  THE  HORSE 

Treatment. — Just  as  has  been  stated  in  discussions  on  the 
subject  of  open  joint,  probing  or  other  instrumentation  is  to  be 
avoided  until  the  exterior  of  the  wound  and  a  liberal  area  sur- 
rounding has  been  thoroughly  cleansed — too  much  importance 
can  not  be  placed  on  this  preliminary  measure.  In  cases  of  open 
joint  where  ragged  wound  margins  exist  and  the  interior  of  the 
joint  capsule  is  contaminated,  much  time  is  required  to 
thoroughly  cleanse  all  soiled  parts.  In  some  instances  an  hour's 
time  is  required  for  this  cleansing  process  after  the  subject  has 
lieen  restrained  and  prepared.  In  order  to  thoroughly  cleanse 
these  delicate  structures  without  doing  them  serious  injury,  one 
ought  to  be  skillful  and  careful  in  all  manipulations  of  the  ex- 
posed parts  of  the  joint  capsule. 

The  general  plan  of  treatment,  after  preliminary  cleansing 
has  been  accomplished,  has  been  outlined  on  page  66  in  the 
consideration  of  scapulohumeral  joint  affections.  The  injection 
of  undiluted  tincture  of  iodin  in  ounce  quantities,  it  must  be 
remembered,  is  not  to  be  done  unless  there  is  provision  for  its 
free  exit.  Where  good  drainage  from  the  joint  cavity  exists 
all  infected  wounds  should  be  thus  treated,  and  this  treatment 
may  be  repeated  as  conditions  seem  to  require — until  infection 
is  checked. 

If  daily  injections  are  necessary,  dilution  of  the  tincture  of 
iodin  with  an  equal  amount  of  alcohol  is  advisable  in  order  to 
avoid  doing  irreparable  damage  to  the  articular  cartilages  and 
synovial  membranes. 

An  antiseptic  powder  composed  of  equal  parts  of  boric  acid 
and  exsiccated  alum  is  employed  to  protect  the  wound  surfaces 
and  the  margins,  and  the  parts  are  then  bandaged.  In  bandag- 
ing wounds  of  this  kind  a  liberal  amount  of  cotton  should  be 
employed,  and  after  a  large  surface  surrounding  the  wound  has 
been  thoroughly  cleansed,  it  must  be  so  kept  thereafter.  This 
is  impossible,  if  one  uses  a  small  amount  of  cotton,  particularly 
if  such  meager  quantity  of  dressing  material  is  carelessly 
wrapped  in  position  with  an  insufficient  amount  of  bandage  ma- 
terial. Mention,  without  description  of  the  elemental  problem 
of  applying  cotton  and  bandages  to  a  wound,  would  be  suffi- 
cient, were  it  not  that  this  is  a  very  important  part  of  the  hand- 


LAMENESS   IN  THE  FORE  LEG  113 

ling  of  such  cases,  and  many  practitioners  are  not  only  thought- 
less in  this  part  of  their  work,  but  also  apparently  careless. 
What  does  it  profit  to  prepare  a  part  and  cleanse  a  wound  with 
painstaking  care  and  then  neglect  to  take  every  possible  precau- 
tion to  prevent  its  subsequent  contamination? 

In  the  handling  of  open  joint  capsules  where  the  perforation 
of  the  capsular  ligament  is  small  and  discharge  of  synovia  does 
not  immediately  follow,  there  is  presented  a  problem  which  is 
difficult  to  decide  upon  and  that  is  the  manner  in  which  such 
wounds  are  to  be  handled.  One  hesitates  to  enlarge  such  open- 
ings to  drain  or  irrigate  the  capsule  when  there  is  no  proof  that 
serious  trouble  will  follow  because  of  infectious  material  which 
has  probably  been  introduced  at  the  time  the  wound  was  in- 
flicted. It  is  especially  difficult  to  decide  upon  the  manner  of 
handling  such  cases  where  the  tarsal  joint  is  wounded,  although 
one  hesitates  to  invade  any  joint  to  the  extent  of  incising  its 
capsule,  unless  there  is  urgent  need  of  so  doing. 

Frost ^  offers  the  following  suggestion  in  such  instances : 
The  treatment  recommended  by  us  for  open  joints,  in  which 
we  wish  to  prevent  ankylosis,  is,  first,  to  shave  all  hair  from  the 
area  surrounding  the  wound,  following  v>'ith  a  thorough  cleans- 
ing of  the  skin  and  disinfection  of  the  v/ouud,  and  then  to  in- 
ject a  twenty  per  cent  Lugol's  solution  in  glycerin  into  the 
wound.  This  should  be  repeated  two  or  three  times  a  day,  each 
time  enough  of  the  solution  being  injected  to  fill  the  joint  cap- 
sule, thereby  securing  the  flushing  effect.  As  this  solution  does 
not  cause  irritation  to  the  tissue  and  yet  is  a  strong  antiseptic, 
it  serves  to  shorten  the  period  of  congestion  and  inflammation 
and  to  overcome  the  infection  without  causing  a  destruction  of 
the  secreting  membrane  until  the  external  wound  has  had  time 
to  heal.  The  injection  of  this  solution  seems  to  retard  the  ex- 
cessive secretion  of  synovia.  The  larger  the  joint  capsule  and 
the  smaller  the  external  wound,  the  longer  our  antiseptic  will 
remain  in  contact  with  the  inflamed  tissues  as  the  glycerin, 
being  thick,  does  not  flow  through  a  small  opening. 

After-care. — Following  the  initial  cleansing  and  treatment  of 
open  joint,  subsequent  dressing  is  necessary  as  frequently  as 
conditions  demand.  If  the  parts  are  badly  infected  and  profuse 
discharge  of  pus  exists  a  daily  change  of  dressings  is  necessary. 

ij.  N.  Frost,  assistant  professor  of  Surgery,  Veterinary  Dept.,  Cornell 
University,  in  "Wound  Treatment,"  page  159. 


il4  LAMENESS  OF  THE  HORSE 

In  the  average  instance,  however,  semi-weekly  treatments  are 
sufficient.  And  in  many  instances  where  one  is  obliged  to  travel 
a  considerable  distance  to  handle  the  affected  animal  one  weekly 
dressing  of  the  wound  will  suffice  after  the  second  treatment. 

The  same  general  plan  of  treatment  concerning  the  subject's 
comfort  that  has  lieen  previously  mentioned  in  arthritis,  is  car- 
ried out  liere.  A  further  and  detailed  consideration  of  the 
subject  of  handling  of  open  joints  follows.^ 

*••  *  *  Such  wounds  may  be  elassifi(Hl  in  two  general  groups 
as  follows:  First,  wounds  in  which  the  trauma  has  exposed 
the  articulation  to  view,  and  second,  those  the  result  of  punc- 
tures, in  which  the  external  wound  is  snmll  and  free  drainage 
is  lacking. 

Wounds  in  which  the  articulation  is  exposed  to  view  have 
drainage  either  all  ready  provided  for,  or  it  is  established  with- 
out hesitancy  surgically.  AVith  free  drainage  thus  established 
there  is  little  or  no  chance  for  the  adjacent  tissues  to  become 
infiltrated  with  infected  wound  discharge.  This  prevents  an 
extension  of  the  injury  and  the  establishment  of  a  good  field 
for  the  growth  of  anaerobic  bacteria. 

Open  joints  caused  by  punctures,  unless  the  puncture  is 
aseptic,  produce  a  swelling  which  is  more  painful  than  is  the 
open  wound  which  exposes  the  joint  to  view.  Especially  is  this 
true  if  the  puncture  is  of  small  diameter,  allowing  the  tissues 
to  partially  close  the  opening  immediately  after  the  wound  has 
been  made.  Where  drainage  is  lacking  there  follows  an  exuda- 
tion which  congests  the  tissues  surrounding  the  injury  and  all 
factors  favoring  germ,  growth  are  present.  It  is  perhaps  advis- 
able to  establish  good  drainage  in  such  cases  as  soon  as  a  diag- 
nosis is  made. 

It  is  not  always  an  easy  matter  to  recognize  an  open-joint, 
when  first  made,  but  twelve  to  twenty-four  hours  later  there  is 
no  cause  for  doubt.  The  condition  is  then  a  very  painful  one ; 
lameness  is  excessive;  there  is  rise  in  temperature;  acceleration 
of  the  pulse  and  manipulation  or  palpation  of  the  region  affected, 
occasions  great  pain. 

The  treatment  of  open  joints  must  be  varied  to  suit  the  dis- 
position of  the  animal,  the  nature  and  location  of  the  injury, 
the  length  of  time  intervening  1)etween  the  infliction  of  the 
wound  and  the  first  attention  given,  and  flie  surroundings  in 
which  the  patient  is  kept. 

In  each  and  every  case  in  which  there  exists  an  open  wound 

'Open  Joints  and  Their  Treatment  in  my  practice,  by  J.  V.  Lacroix,  Amer- 
ican Journal  of  Veterinary  Medicine,  Vol.  5,  page  203. 


LAMENESS   IN  THE  FORE  LEG  115 

the  surface  surrountlinti'  tlie  wound  is  cleansed  thoroughly,  the 
hair  is  shaved  if  possible,  and  the  margin  of  the  wound  is  cur- 
retted  and  cleansed  thoroughly  with  antiseptic  solutions. 

If  there  is  evidence  that  the  articulation  contains  infective 
material,  it  is  washed  out  with  copious  quantities  of  peroxide 
of  hydrogen — usually  as  nnicli  as  six  or  eight  ounces.  This  is 
followed  by  injection  of  an  ounce  or  two  of  tincture  of  iodin. 
Even  though  the  joint  appears  to  be  clean  some  tincture  of  iodin 
is  used,  as  it  checks  the  secretion  of  synovia  and  is,  in  every 
way,  beneficial.  Care  is  taken  to  apply  the  iodin  also  to  the  sur- 
face immediately  surrounding  the  wound.  The  entire  wound  is 
then  covered  with  a  dusting  powder  composed  of  zinc  oxide,  boric 
acid,  exsiccated  alum,  phenol  and  camphor. 

This  powder  is  used  in  abundance  and  the  wound  is  then 
covered  with  a  heavy  layer  of  absorbenc  cotton  and  well  ban- 
daged. This  bandage  is  not  disturl)ed  for  at  least  three  days 
and  may  be  left  in  place  for  a  week.  In  cases  in  which  it  is 
necessary  to  keep  the  dressing  on  for  a  Vv'cek,  or  in  cases  where 
the  patient  is,  through  necessity,  kept  in  quarters  that  are  wet 
or  unclean,  the  first  bandage  is  covered  with  a  layer  of  oakum 
which  has  been  saturated  in  oil  of  tar  and  this  in  turn  is  held 
in  place  by  means  of  several  layers  of  bandages.  The  Ijandages 
are  also  saturated  with  oil  of  tar. 

In  from  one  to  two  months  wounds  so  treated,  unless  they  are 
foot-wounds,  will  be  ready  to  dress  without  being  bandaged. 
It  is  ordinarily  unnecessary  to  dress  foot-wounds  oftener  than 
every  second  week  after  the  discharge  of  synovia  has  ceased. 
When  the  wound  has  filled  with  granulation,  a  protective  dress- 
ing is  applied  which  is  rendered  water  proof  by  the  use  of 
bandages  covered  with  oil  of  tar.  The  patient  can  now  be  turned 
out  for  a  month  or  six  weeks  without  disturbing  the  dressing. 
After  the  removal  of  the  bandages,  the  only  treatment  necessary 
is  an  occasional  application  of  some  mildly  antiseptic  ointment. 

Except  in  nail  pricks  of  the  foot,  occasioned  by  punctures,  a 
five  per  cent  tincture  of  iodin  is  injected  into  open  joints,  if  the 
wound  renuiins  sufficiently  open,  and  this  treatment  is  continued 
so  long  as  there  is  a  discharge  of  synovia.  Surgical  drainage  is 
established  if  it  is  considered  practicable  and  the  remainder  of 
the  treatment  is  about  the  same  as  for  wounds  which  are  open. 

Open  joints  occur  in  horses  at  pasture  and  are  sometimes  not 
discovered  until  several  days  or  a  week  after  the  injury,  and  in 
some  instances  the  wounds  are  filled  with  maggots.  The  only 
difference  in  the  treatment  of  these  cases  is  that  more  time  and 
care  is  taken  in  cleansing  the  wound,  more  curetting  is  neces- 
sary, and  after  cleansing  the  Avound  with  peroxide  of  hydrogen, 


116  LAMENESS  OF  THE  HORSE 

the  joint  is  thoroughly  washed  out  with  equal  parts  of  tincture 
of  iodiu  and  chloroform.  This  is  follo\\ed  by  the  injection  of  a 
quantity  of  seventy-five  percent  alcohol  and  the  wound  is  dressed 
and  bandaged  as  already  described.  At  each  subsequent  dressing 
of  infected  wounds  so  treated  less  suppuration  is  noticed  and 
the  synovial  discharge  usually  ceases  in  from  one  to  two  months. 
About  ninciij  percent  of  all  cases  of  open  joint  make  complete 
recoveries,  about  four  per  cent  partially  recover  and  six  per  cent 
are  fatal.  Among  the  fatal  cases  are  the  open  joints  with  com- 
plications as  severed  tendons,  those  occasioned  by  calk  wounds 
in  horses  that  are  stabled,  and  nail  punctures  of  the  feet.  The 
foUoAving  report  of  twelve  favorable  cases  is  taken  from  a  record 
of  sixty-two  cases.  The  favorable  ones  are  reported,  chiefly 
because  there  are  now  enough  reports  on  record  of  such  cases 
which  have  terminated  fatally. 

Case  1. — A  gray  gelding  used  as  a  saddle  pony  received  a 
horizontal  wire  cut  laying  completely  bare  the  scapulohumeral 
articulation.  The  margins  of  the  wound  were  cleansed  as  here- 
tofore described,  a  drainage  was  provided  surgically,  tincture  of 
iodin  was  injected  and  the  wound  was  covered  with  equal  parts 
of  boric  acid  and  exsiccated  alum.  The  iiorse  was  kept  tied  and 
a  diluted  tincture  of  iodin  was  injected  into  the  wound  once 
daily  and  the  powder  applied  often  enough  to  keep  the  wound 
covered.  The  case  made  a  complete  recovery  and  the  pony  was 
again  in  service  within  sixty  days. 

Case  2. — A  twelve-hundred-pound  bay  mare  with  an  open  car- 
pal joint.  The  wound  was  an  open  one  al)Out  two  and  one-half 
inches  in  length,  and  made  transversely  and  when  the  member 
was  flexed  the  articular  surface  of  the  carpal  bones  were  pre- 
sented to  view.  An  ounce  of  tincture  of  iodin  was  injected  into 
this  joint  after  having  cleansed  the  margin  of  the  wound  and 
the  mare  was  cross-tied  in  a  single  stall  to  keep  her  from  lying 
down.  The  owner  was  instructed  to  keep  the  outside  of  the 
wound  powdered  with  air  slaked  lime  and  a  very  unfavorable 
prognosis  was  given. 

I  heard  nothing  further  from  this  case  until  fifty-nine  days 
from  the  date  of  the  injury,  when  I  met  the  owner  driving  this 
mare  to  a  buggy.  The  wound  had  healed  by  first  intention  and 
at  that  time  so  little  cicatrix  remained  that  it  was  difficult  to 
find  it. 

Case  3. — A  brown  mare  with  an  open  fetlock  joint  due  to  a 
spike-nail  puncture.  Lameness  was  excessive,  and  joint  greatly 
swollen.  Tincture  of  iodin  was  injected  into  the  wound  and 
towels  dipped  in  hot  antiseptic  solutions  were  applied  for  several 


LAMENESS   IN  THE  FORE  LEG  117 

hours  daily  until  the  acute  stage  had  passed.  Later  the  mare 
was  turned  out  to  pasture  and  a  vesicant  was  applied  once  or 
twice  a  month  until  recovery  was  complete  which  was  in  about 
six  months. 

Case  4. — A  four-year-old  bay  mare  having  a  wire-cut  which 
opened  the  tarsus  joint  was  treated  as  heretofore  described.  The 
wound  was  kept  bandaged  for  about  two  weeks  and  later  it  was 
dressed  without  being  bandaged.  In  ninety  days  she  had  com- 
pletely recovered. 

Case  5. — A  twelve-year-old  mare  with  an  open  fetlock  joint 
due  to  a  puncture  wound.  The  margins  of  the  wound  were 
cleansed  and  the  external  wound  enlarged  to  facilitate  drainage. 
Tincture  of  iodin  was  injected;  the  wound  was  bandaged  and 
dressed  for  a  month  in  the  manner  heretofore  described,  when 
all  discharge  had  stopped.  A  vesicant  was  applied;  the  mare 
was  put  to  pasture  and  within  sixty  days  from  the  date  of  the 
injury  she  was  being  driven  on  short  trips. 

Case  6. — A  two-year-old  brown  gelding  with  a  wire-cut  on 
the  left  front  foot.  The  wound  extended  down  through  the  sole 
and  opened  the  navicular  joint.  This  colt  was  very  wild  and  it 
was  necessary  to  tie  it  down  each  time  the  wound  was  dressed 
The  wound  was  dressed  weekly  for  a  month  and  less  frequently 
thereafter.  It  was  handled  eight  times;  the  last  dressing  was 
left  in  place  until  worn  out.  Six  months  later  the  colt  was  prac- 
tically well,  a  very  little  lameness  being  shown  when  walking 
on  frozen  ground. 

Case  7. — A  seven-year-old  saddle-horse  weighing  eleven  hun- 
dred and  fifty  pounds  received  a  wound  of  the  tarsus,  laying 
bare  the  articular  surfaces  of  a  part  of  the  joint.  It  was  im- 
possible to  keep  this  wound  bandaged  because  of  the  restless 
disposition  of  the  subject.  Injections  of  a  dilute  tincture  of 
iodin  were  emploj^ed  every  second  or  third  day  for  a  month 
and  the  wound  was  kept  covered  with  the  antiseptic  dusting 
powder  referred  to  heretofore.  In  five  months  complete  recovery 
had  taken  place,  with  the  exception  of  a  stubborn  skin  disturb- 
ance which  was  successfully  treated  six  months  after  the  wound 
was  inflicted.  The  horse  is  still  in  use  and  is  absolutely  free 
from  lameness. 

Case  8. — A  two-year-old  brown  gelding  with  a  wire-wound 
opening  the  scapulohumeral  joint.  This  wound  was  large  enough 
to  expose  to  view  the  articular  portion  of  the  humerus.  The  same 
treatment  as  that  given  case  No.  one  was  instituted  and  in  ninety 
days  the  colt  was  practically  well. 


118  LAMENESS  OF  THE  HORSE 

Case  9. — A  three-year-old  bay  filly  was  found  at  pasture  with 
one  fore  foot  badly  injured.  The  owner  intended  to  destroy  her, 
hut  a  neighbor  prevailed  upon  him  to  have  her  treated.  Ap- 
parently the  wound  was  of  about  a  week's  standing  and  in  a 
very  bad  condition,  filled  with  maggots  and  dirt.  Both  the 
navicular  and  coronary  articulations  were  open.  This  wound 
was  cleansed  in  the  usual  manner  and  the  owner  cared  for  the 
case  the  balance  of  the  time  because  the  distance  from  my  office 
was  too  great  to  give  her  personal  attention.  She  made  an  al- 
most complete  recovery  in  five  months. 

Case  10. — At  two-year-old  mule  with  an  open  navicular  joint 
due  to  a  barbed  wire  wound.  Usual  care  was  given  this  case  and 
in  five  months  recovery  was  complete  and  little  scar  is  to  be 
seen.     This  case  received  seven  treatments. 

Case  11. — An  eighteen-months-old  colt  at  pasture  was  found 
down  and  unable  to  rise  without  help.  In  addition  to  several 
wounds  of  lesser  importance  there  was  a  large  wound  on  the 
inner  side  of  the  elbow,  the  joint  was  open  and  the  entire  leg 
was  greatly  swollen  and  in  a  state  of  acute  infectious  inflamma- 
tion. The  colt  could  not  walk,  its  temperature  was  105°,  pulse 
was  rapid  and  respiration  was  a  little  hurried.  After  advising 
the  owner  to  put  the  poor  animal  out  of  its  misery  I  left  the 
place.  Four  clays  later  the  owner  came  to  my  office  and  asked 
if  he  could  borrow  some  old  shears  to  "trim  off  some  loose  hide 
from  that  colt."  He  left  the  colt  in  the  pasture  and  all  the 
care  it  received  was  the  regular  application  of  a  proprietary 
dusting  powder.     It  made  a  complete  recovery. 

Case  12. — A  family  mare,  heavy  in  foal,  received  a  vertical 
wound  of  the  fetlock  joint  inflicted  by  a  disc-harrow.  The  cid- 
de-sac  of  the  ligament  of  this  joint  was  opened  freely.  The 
wound  was  dressed  in  the  usual  manner  and  again  three  days 
later  when  no  suppuration  had  ta  _m  place.  Four  days  later 
the  patient  gave  birth  to  a  colt  and  suckled  it  right  along  through 
her  convalescence.  This  wound  healed  by  first  intention  and 
seventy-nine  days  from  the  date  of  the  injury  the  mare  was 
driven  to  town,  two  and  one-half  miles  distant,  and  showed  but 
little  lameness. 

Phalangeal  Exostosis  (Ringbone) 

This  tci'iii  is  applied  to  exostoses  involving  the  first  and  second 
phalanges  (suffraginis  and  corona),  regardless  of  their  size,  ex- 
tent or  location.  It  is  a  misnomer,  in  a  sense,  and  the  veter- 
inarian is  frequently  obliged  to  spend  considerable  time  with  his 


LAMENESS  IN  THE  FORE  LEG  119 

clients  in  order  to  convince  tlicni  that  a  spherodial  exostosis  of 
the  proximal  phalanx,  in  certain  cases,  is  in  reality  ' '  ringbone, ' ' 
even  though  there  exists  no  exostosis  which  completely  encircles 
the  affected  bone. 

Etiolog'y  and  Occurrence. — Exostosis  of  the  first  and  second 
phalanges  is  usually  due  to  some  form  of  injury,  whether  it  be  a 
contusion,  a  lacerated  wound  which  damages  the  periosteum,  or 
periostititis  and  osteitis  incited  by  concussions  of  locomotion, 
or  ligamentous  strain.  Practically  the  only  exception  is  in  the 
rachitic  form  of  ringbone  which  affects  young  animals. 

There  are  predisposing  causes  that  merit  consideration,  chief 
among  which  is  the  normal  conformation  of  the  coronet  joint. 
This  proclivity  is  constant ;  the  normal  interphalangeal  articula- 
tion is  an  incomplete  ginglymoid  joint  and  while  its  dorso-volar 
diameter  is  great,  this  in  no  wise  compensates  for  its  dispropor- 
tionately narrow  transverse  diameter.  The  pivotal  strain  which 
is  sometimes  thro^Ml  upon  this  articulation  when  an  animal  turns 
on  one  foot,  as  well  as  the  tension  which  is  put  on  the  collateral 
ligaments  when  the  inner  or  the  outer  quarter  of  the  foot  rests 
in  a  depression  of  the  road  surface,  tends  to  detach  the  insertion 
of  these  ligaments  or  to  cause  fibrillary  fractures  of  their  sub- 
stance. 

Short,  upright,  pasterns  receive  greater  concussion  during  fast 
travel  on  hard  roads  than  do  the  longer  more  sloping  and  well 
formed  extremities.  Those  who  are  advocates  of  the  theory  that 
this  type  of  osteitis  with  its  complications  has  its  origin  in  the 
articular  portion  of  the  joint,  claim  that  the  upright  pastern  con- 
stitutes an  important  tendency  toward  ringbone.  Howbeit,  ring- 
bone is  an  active,  serious  and  frequent  cause  of  lameness  and  it 
affects  animals  of  all  ages  and  occurs  under  various  conditions. 
Horses  having  good  conformation  and  kept  at  work  wherein  no 
great  amount  of  strain  is  put  upon  these  parts,  are  occasionally 
victims  of  this  affection. 

Classification. — The  arrangement  employed  by  Moller^  is  in- 
tensely practical  and  logical.  He  considers  ringbone  as  articu- 
lar, periarticular,  rachitic  and  traumatic.     A  mode  of  classifica- 

iRegional  Veterinary  Sui-gery  MiiUer — Dollar,  page  G05. 


120  LAMENESS  OF  THE  HORSE 

tion  that  is  common  and  in  a  practical  way,  good,  is,  high  and 
low  ringbone.  When  prognosis  is  considered,  for  instance,  it  is 
very  convenient  to  state  that  the  chances  for  recovery  are  much 
better  in  high  ringbone  than  in  low  ringbone.  The  classification 
of  ]\Ioller  will  be  followed  here. 

Symptomatology. — In  all  forms  of  incipient  ringbone  except 
rachitic,  the  first  manifestation  of  its  existence,  or  of  injury  to 
the  ligaments  in  the  region  of  the  pastern  joint  which  causes 


Fig.  17 — Phalangeal  exostoses. 


periostitis,  or  affections  of  the  articular  portions  of  the  proximal 
inter-phalangeal  joint,  is  lameness.  Lameness  which  typifies 
ringbone  is  of  the  supporting-leg  variety  and  by  compelling  the 
subject  to  step  from  side  to  side,  marked  flinching  is  observed, 
especially  in  periarticular  ringbone;  causing  the  affected  animal 
to  turn  abruptly  on  the  diseased  member,  using  it  as  a  pivot, 
likewise  accentuates  the  manifestation.  In  fact,  many  subjects 
that  exhibit  no  evidence  of  locomotory  impediment  while  walking 
or  trotting  in  a  straight  line  on  a  smooth  road  surface,  will  mani- 
fest the  characteristic  form  of  lameness  from  ringbone  when  the 
aforementioned  side  to  side  movement  is  performed. 


LAMENESS   IN  THE  FORE  LEG 


121 


When  the  manner  in  which  pain  is  occasioned  is  considered,  it 
will  be  understood  why  lameness  is  intermittent  in  the  early 
stages  of  this  affection  and  may  even  be  unnoticed  by  the  driver. 
An  animal  may  travel  on  a  smooth  road  without  giving  evidence 
of  any  inconvenience,  but  as  soon  as  a  rough  and  irregular  pave- 
ment or  road  surface  is  reached,  will  limp.  As  the  subject  is 
driven  farther  on  level  streets  the  lameness  may  disappear.  This 
intermittent  type  of  lameness  may  continue  until  there  is  de- 
veloped a  large  exostosis,  or  until  articular  involvement  causes 


Fig.  18 — Rarefying  osteitis   in   chionic  ringbone  and  ossification    of  lateral 
cartilages. 


SO  much  distress  during  locomotion  that  lameness  is  constant. 
On  the  other  hand,  resolution  may  occur  during  the  stage  of 
periosteal  inflammation,  oi',  an  exostosis  forms  which  causes  no 
interference  with  function. 

Before  there  is  evidence  of  an  exostosis,  diagnosis  of  ringbone 
is  not  easy,  for  it  is  then  a  problem  of  detecting  the  presence  of 
a  ligamentous  sprain,  periostitis,  or  osteitis.  The  diagnostician 
should  take  note  of  local  manifestations  of  hypersensitiveness,  or 
heat  if  such  exist,  and,  in  addition,  other  conditions  must  be  ex- 
cluded before  definite  conclusions  are  possible. 

In  articular  ringbone  as  soon  as  there  is  developed  an  exostosis, 


122  LAMENESS   OF  THE  HORSE 

it  occupies  a  position  on  the  dorsal  (anterior)  part  of  the  articu- 
lation and  extends  around  the  sides  of  the  joint. 

Periarticular  ringbone  is  characterized  hy  exostoses  which 
are  situated  on  the  sides  of  the  phalanges  and  not  extending 
around  to  the  anterior  part  of  the  joint.  This  type  of  ringbone 
as  well  as  the  articular  may  occur  "high"  or  "low." 


Fig-.  19 — Phalangeal   exostoses   in    chronic   ringbone.     Museum   specimen    of 
the  Kansas  City  Veterinary  College. 

With  the  trau malic  form  of  ringbone,  all  consequences,  as  to 
the  size  and  form  the  exostosis  is  to  assume,  depend  upon  the 
nature  and  extent  of  the  injury. 

Rachitic  ringbone  is  frequently  observed  in  some  sections  of 
tlie  country  and  docs  not  oi-diiiarily  cause  much  if  any  lameness. 
It  is  a  disease  of  colts  and  may  affect  one  or  all  of  the  phalanges 
at  the  same  time.  As  the  sul)jcct  advances  in  age  there  is  more 
or  less  diminution  in  the  size  of  the  enlargements. 


LAMENESS   IN  THE  FORE  LEG  123 

Treatment. — Rest  is  essential  in  the  treatment  of  ringbone. 
If  diagnosed  during  its  ineipieney,  remedial  measures  such  as 
are  usually  employed  to  treat  sprains,  are  indicated  and  hiter 
the  parts  should  be  blistered.  When  an  exostosis  has  developed 
puncture  firing  is  the  remedy  par  excellence.  Not  that  this 
method  of  treatment  is  infallible,  for  to  any  thinking  one  who 
takes  into  consideration  the  pathological  anatomy  of  this  condi- 
tion, it  is  evident  that  no  manner  of  treatment  is  beneficial  in 
some  eases.  If  the  exostosis  is  so  situated  that  it  does  not  me- 
chanically interfere  with  function,  and  is  not  so  large  that  it 
may  inhiliit  flexion  and  extension,  and  where  the  articular  por- 
tions of  the  joint  are  not  eroded,  good  results  attend  the  use  of 
the  actual  cautery. 

In  firing,  after  having  anesthetized  the  extremity,  and  pre- 
pared the  surgical  area,  the  cautery  is  deeply  inserted  in  numer- 
ous places,  taking  care,  however,  not  to  open  the  joint.  The  parts 
are  immediately  covered  with  aseptic  absorbent  cotton  and  this 
dressing  is  left  in  position  for  forty-eight  hours  and  if  perchance 
there  is  evidence  of  synovial  discharge,  the  parts  are  again 
aseptically  dressed  in  order  to  prevent  infection  of  the  articula- 
tion. If,  as  is  the  case  usually,  no  perforation  of  the  joint  cap- 
sule exists,  the  openings  made  by  the  cautery  have  been  closed 
by  the  coagulation  of  serum  and  there  is  then  little  chance  of 
infection  causing  troul)le,  even  though  the  member  is  left  un- 
bandaged. 

In  several  instances,  the  author  has  treated  ringl)one  by  this 
method  where  the  periarticular  type  existed  and  lameness  was 
marked,  and  in  three  weeks  the  subjects  were  in  service  and  not 
lame — this,  in  one  instance  in  a  valual)le  polo  pony  where  the 
subject  continued  in  service  for  more  than  a  year  without  any 
evidence  of  recurrence  of  the  lameness.  The  production  of  a 
deep-seated  and  acute  inflammation  with  the  actual  cautery  is 
preferable  to  any  sort  of  counter-irritation  which  may  be  pro- 
duced by  vesicants. 

There  is  no  occasion  for  any  ditfereuce  in  the  treatment  of 
either  of  the  first  three  classes  of  ringbone,  l)ut  in  the  rachitic; 
type  where  treatment  is  given,  the  application  of  a  vesicant  is 


124  LAMENESS  OF  THE  HORSE 

all  that  is  required.  In  most  instances  treatment  is  not  neces- 
sary. 

The  affected  animals  require  a  month  to  three  months'  time 
for  recovery  to  take  place  in  the  average  favorable  cases  of  ring- 
bone. 

Median  neurectomy  is  of  service  in  many  instances  where 
lameness  is  not  completely  relieved  by  the  use  of  the  actual 
cauteiy  and  no  bad  results  attend  the  performance  of  this  opera- 
tion even  though  no  benefit  is  derived  thereby.  Plantar  neu- 
rectomy is  contraindicated  in  all  cases  where  there  exists  much 
lameness.  If  lameness  is  due  to  acute  inflammation  bad  results 
such  as  sloughing  and  loss  of  the  hoof  may  follow ;  and  if  large 
exostoses  mechanically  interfere  with  function  of  the  joint,  or 
where  articular  erosions  exist,  no  possible  good  can  come  from 
neurectomy.  Careful  discrimination  should  be  employed  in  se- 
lecting cases  for  neurectomy  for  this  operation;  otherwise,  it  is 
very  likely  to  prove  disappointing. 

Open  Sheath  of  the  Flexors  of  the  Phalanges. 

This  condition  does  not  differ  from  a  like  affection  involving 
other  tendons  except  that  the  function  of  these  tendons  is  such 
that  large  synovial  sheaths  are  necessary,  and  when  synovitis 
exists,  the  condition  then  becomes  more  serious. 

Infectious  synovitis  involving  these  tendons  in  the  fetlock 
region  is  of  more  frequent  occurrence  than  a  like  affection  of 
carpal  or  tarsal  sheaths.  With  the  exception  of  the  extent  of 
the  involvement  and  distress  occasioned  thereby,  synovitis  the 
result  of  open  tendon  sheaths,  is  similar  wherever  it  occurs. 

Etiology. — The  same  conditions  which  are  responsible  for 
open  fetlock  joint  and  other  wounds  of  the  pastern  region,  cause 
open  tendon  sheaths  of  the  flexor  tendons. 

Symptomatology. — Because  of  the  size  and  extent  of  this 
slicalli  and  the  different  manner  in  whidi  it  is  opened,  there  is 
manifested  dissimilar  symptoms  in  different  cases.  A  nail 
puncture  which  perforates  the  sheath  in  the  pastern  region  and 
at  the  same  time  produces  an  infectious  synovitis,  will  cause 
a  markedly  different  manifestation  than   will  a  wound  which 


LAMENESS   IN  THE  FORE  LEG  125 

freely  opens  the  sheath  above  the  fetlock.  In  the  first  instance, 
the  condition  is  much  more  painful;  swelling  is  intense  in  some 
cases;  and  if  the  subject  does  not  possess  sufficient  resistance  so 
that  spontaneous  resolution  promptly  occurs,  surgical  evacua- 
tion of  pus  is  usually  necessary.  When  these  tendon  sheaths 
are  opened,  there  follows  a  reaction  which  is  quite  analogous  to 
that  which  exists  in  arthritic  synovitis,  but  instead  of  ankylosis, 
adhesions  with  thecal  obliteration  occur.  Rarely  there  result 
cartilaginous  and  osseous  formations. 

The  constitutional  disturbances  Avhich  characterize  this  con- 
dition vary  with  the  degree  of  distress  occasioned.  As  the  in- 
fection is  virulent  and  causes  serious  destruction  of  the  affected 
parts,  so  does  evidence  of  malaise  and  finally  distress  appear. 
Detailed  discussions  of  symptomatology  in  similar  conditions 
have  heretofore  been  given,  and  further  repetition  is  unneces- 
sary. 

Treatment. — The  same  general  plan  of  treatment  which  is 
employed  for  handling  open  joint  is  put  in  practice  in  these 
cases.  Following  the  preoperative  cleansing  of  the  exteriuil 
wound  and  adjacent  surfaces,  where  lilieral  drainage  exists, 
tincture  of  iodin  is  injected  into  the  sheath,  the  parts  covered 
with  a  suita])le  dressing  powder,  and  th^  entire  meml)er  is  care- 
fully dressed  with  cotton  and  bandages. 

Subsequent  treatment  is  the  same  as  has  been  outlined  \n  the 
discussion  of  open  fetlock  joint  on  page  112.  The  same  general 
plan  of  after-care  is  necessary.  Recovery,  however,  does  not 
require  so  much  time  ordinarily,  yet  punctures  of  the  sheath 
occasioned  by  nails  or  other  siiuiU  implcmeiiis  make  for  long 
draAvn  out  cases  of  infective  synovitis. 

Luxation  of  the  Fetlock  Joint. 

Etiology  and  Occurrence. — The  numner  of  construction  of 
the  fetlock  joint  is  such  that  disarticulntion  without  irreparable 
injury  resulting,  is  practically  impossil)l\  Logically,  this  joint 
in  the  fore  legs  (not  so  in  the  pelvic  limbs)  should  disarticulate 
in  such  nu^mer  that  eitlier  all  of  the  inhibitory  apparatus  (flexor 
tendons  and  suspensory  ligament)  nnist  rupture  or  a  lateral 
luxation  is  necessary.     Lateral  disarticulation  must  necessarily 


126  LAMENESS  OF  THE  HORSE 

sever  the  attachment  of  one  of  the  common  collateral  ligaments. 
Because  of  the  width  (transverse  diameter)  of  the  articulating 
surfaces  of  this  joint,  lateral  luxation  requires  a  great  strain; 
and  a  force  that  is  sufficient  to  occasion  this  trauma  usually 
causes  serious  additional  injury.  Therefore,  the  condition  is 
considered  one  wherein  prognosis  is  always  unfavoral)le  in  so 
far  as  practical  methods  of  treatment  are  concerned. 

Mr.  A.  Barbier^  reports  a  case  of  bilateral  luxation  of  the  fet- 
lock joints  of  the  hind  legs  in  a  horse.  This  was  done  in  jump- 
ing, and  the  extensor  tendon  of  each  leg  was  ruptured  and  the 
anterior  portion  of  the  metatarsus  was  protruding  tli rough  the 
skin.  Profuse  hemorrhage  had  taken  place  due  to  tearing  of 
the  blood  vessels. 

Symptomatology. — Entire  luxation  of  this  joint  when  present 
is  so  evident  that  one  cannot  fail  to  recognize  the  condition. 
Complete  disarrangement  of  normal  relation  occurs  and  there  is 
either  a  breaking  down  of  the  inhil)itory  njiparatus,  or  if  a  lateral 
disarticulation  exists,  the  normally  straight  line  formed  by  the 
bones  of  the  front  leg,  as  viewed  from  the  front  or  rear,  is  broken 
at  the  fetlock. 

Often  fracture  of  bones  are  concomitant  and  then,  of  course, 
mobility  is  increased  and  not  decreased  as  is  the  case  in  un- 
complicated luxation. 

Such  violence  occurs  at  times,  when  this  joint  is  disarticulated, 
that  the  joint  capsule  is  also  completely  ruptured  and  the  articu- 
lar portion  of  the  bones  is  exposed  to  view. 

Treatment.— The  condition  being  practically  a  hopeless  one, 
destruction  of  the  subject  is  the  thing  which  should  be  promptly 
done.  Tn  valuable  breeding  animals,  owners  may  prefer  that 
treatment  be  attempted  when  a  lateral  luxation  and  detachment 
of  but  one  common  ligament  have  permitted  luxation  without 
complete  disarticulation  and  rupture  of  the  joint  capsule.  In 
such  eases,  by  immobilizing  the  affected  parts  as  in  fracture, 
and  confining  the  subject  in  a  sling  for  about  sixty  days,  partial 
recovery  may  occur  in  some  instances. 

Experience  has  shown  that  where  luxation  with  detachment  of 


^Extract    from    Receuil    de    M^decine    V^t^rinaire    in    Ameircan    Veterinary 
Review,  Vol.  23,  p.  893. 


LAMENESS   IN  THE  FORE  LEG  127 

a  collateral  ligament  occurs,  recovery  is  slow  and  incomplete — • 
there  always  results  considerable  exostosis  at  the  site  of  injury. 

Sesamoiditis. 

Etiology  and  Occurrence. — Inflammation  of  the  proximal 
sesamoid  Ijones  is  caused  by  any  kind  of  irritation  which  may 
involve  this  part  of  the  inhibitory  apparatus.  Positioned  as 
they  are,  between  the  bifurcations  of  the  suspensory  ligament 
and  the  pastern  joint,  they  serve  as  fulcra  and  effectively  assist 
in  minimizing  concussion  which  is  received  by  the  suspensory 
ligament.  The  flexor  tendons  also,  in  contracting,  exert  strain 
upon  the  inter-sesamoidean  ligament,  which  has  a  similar  effect 
upon  the  sesamoid  bones  as  that  which  is  produced  by  the  sus- 
pensory ligament. 

The  condition  occurs  quite  frequently,  and  because  of  the 
important  function  performed  by  these  bones,  active  inflamma- 
tion of  the  sesamoids  constitutes  a  serious  affection.  Because 
of  the  fact  that  these  bones  have  proportionately  large  articular 
surfaces,  when  they  are  inflamed  to  the  extent  that  degenerative 
changes  affect  the  articular  cartilage,  complete  recovery  seldom 
results. 

The  same  pathological  changes  occur  here  that  are  to  be  seen 
in  any  case  of  arthritis.  No  special  pathological  condition  char- 
acterizes sesamoiditis  but  this  condition  causes  incurable  lame- 
ness when  the  sesamoid  bones  are  much  inflamed. 

Symptomatology. — In  acute  inflammation,  there  exist  all  tlie 
symptoms  which  portray  any  arthritic  inflammation  of  like  char- 
acter. The  parts  are  readily  palpable  and  are  found  to  be  hot, 
supersensitive,  and  more  or  less  infiltration  of  the  tissues  con- 
tiguous to  the  joint  causes  swelling.  There  is  volar  flexion  of  the 
phalanges  when  the  subject  is  at  rest.  Lameness  is  intense ;  in 
some  acute  inflammatory  disturbances  the  subject  is  unable  to 
bear  weight  on  the  affected  member. 

In  chronic  sesamoiditis,  constant  lameness  is  the  one  salient 
feature  which  marks  the  condition.  While  it  is  possible  for  one 
sesamoid  bone  to  become  involved  without  its  fellow  being  af- 
fected, this  is  not  usual.  Considerable  organization  of  tissue 
surrounding  the  joint  is  present  and  no  particular  evidence  of 


128  LAMENESS  OF  THE  HORSE 

siipersensitiveness  exists.  However,  supporting  weight  brings 
sufficient  pressure  to  bear  upon  the  intlamed  and  more  or  less 
eroded  Imnes  so  that  pain  is  occasioned  and  lameness  results. 

Treatment. — During  acute  inflammation,  absolute  quiet  is. 
of  course,  of  first  consideration.  Cold  packs  are  to  be  kept  in 
contact  with  the  parts  until  acute  inflammatory  symptoms  sub- 
side. The  fetlock  region  is  then  enveloped  with  a  poultice  or  an 
iodin  and  glycerin  combination  (iodin  one  part  to  seven  parts 
of  glycerin)  is  applied  and  a  dressing  of  cotton  is  kept  in  con- 
tact with  the  inflamed  region.  Following  this,  a  vesicant  is  em- 
ployed and  the  subject  is  allowed  a  month's  rest. 

Tn  sub-acute  cases,  the  entire  region  .surrounding  the  pastern 
is  blistered  or  the  actual  cautery  is  used.  Line-firing  is  pref- 
erable. The  subject  is  given  a  month  or  six  weeks  rest  and  one 
may  be  guided  by  the  presence  or  absence  of  lameness  as  to 
whether  improvement  or  recovery  i.s  taking  place. 

Old  chronic  cases,  and  particularly  those  where  there  are  con- 
siderable induration  and  fibrous  organization  of  tissue  surround- 
ing the  joint,  are  not  to  be  benefited  by  treatment. 

The  chief  consideration  in  handling  sesamoiditis  is  checking 
inflammation  as  early  as  possible  and  preventing,  if  this  can  be 
done,  the  erosion  of  articular  surfaces.  If  destruction  of  any 
part  of  the  articular  surfaces  can  be  prevented  and  the  patient 
allowed  ample  time  for  complete  resolution  of  the  affected  parts 
to  occur,  permanent  relief  is  possible. 

Fracture  of  the  Proximal  Sesamoids. 

Etiology  and  Occurrence. — Fracture  of  the  proxinud  sesa- 
moid bones  is  caused  l)y  violent  strain  when  there  exists  fragilitas 
ossenm,  or  by  contusions.  The  author  treated  a  case  where 
fracture  of  one  sesamoid  was  occasioned  by  a  horse  receiving  a 
puncture  wound  wherein  the  sharp  end  of  a  steel  bar  was  pro- 
truding from  the  ground  where  it  was  firmly  embedded.  The 
subject  in  this  case  was  injured  while  being  driven  along  a 
country  road.  Frost^  reports  simultaneous  fracture  of  all  of  the 
proximal  sesamoids  occurring  in  a  sixteen-year-old  pony.     The 

'Fracture  of  All  the  Sesamoid  Bones,  by  R.  F.  Frost,  M.  R.  C.  V.  S., 
A.  V.  D.,  Rangoon,  Burmah,  in  American  Veterinary  Review,  Vol,  5,  p.  362. 


LAMENESS   IN  THE  FORE  LEG  129 

condition  is  of  rather  common  occurrence  in  some  countries  be- 
cause of  tlie  fragile  condition  of  horses'  bones. 

Symptomatology. — If  the  parts  can  be  examined  before  ex- 
travasation of  l)lo()d  and  swelling  mask  the  condition,  crepita- 
tion may  be  detected.  In  other  instances,  it  is  possible  to  note  a 
displacement  of  parts  of  the  sesamoid  bones — this  in  horizontal 
fracture.  There  occurs  more  or  less  descent  of  the  fetlock  which 
must  not  be  attributed  to  rupture  of  the  superficial  tlexor  tendon 
(perforatus).  By  outlining  the  course  of  this  tendon  with  the 
fingers,  when  it  is  passively  tensed  sufficiently  to  follow  its  course, 
one  may  exclude  rupture  of  the  superficial  flexor.  Finding  the 
suspensory  ligament  intact  from  its  origin  to  the  sesamoid  at- 
tachments, one  may  also  eliminate  rupture  of  this  structure  as 
a  cause  of  the  trouble.  Needless  to  say,  marked  lameness  and 
swelling  of  the  fetlock  soon  take  place.  The  condition  is  painful, 
and  ordinarily,  recovery  is  impossil)le. 

Treatment. — Where  treatment  is  attempted,  immobilization 
as  in  luxation  is  in  order.  The  patient's  comfort  is  sought,  and 
if  the  fractured  parts  can  be  kept  in  close  proximity,  their  union 
may  occur  in  time.  However,  chances  for  partial  recovery 
(which  is  the  best  to  be  hoped  for)  are  so  remote  that  early  de- 
struction of  the  subject  is  the  humane  and  economical  thing  to 
do. 

Where  treatment  is  instituted,  it  is  found  that  there  is  required 
a  long  time  for  union  of  the  fractured  bones  to  occur  (where 
union  does  take  place)  and  the  cost  of  treatment  together  with 
the  uncertainty  of  even  partial  recovery,  makes  for  an  unfavor- 
able outcome.  When  the  best  possi])le  results  succeed  treatment, 
a  large  callosity  is  formed  and  movement  of  the  pastern  joint 
is  restricted.  Lameness,  though  not  intense,  in  the  case  referred 
to,  where  one  bone  was  broken,  was  i)ermanent  and  the  subject 
was  out  of  service  for  nearly  a  year. 

Inflammation  of  the  Posterior  Ligaments  of  the  Pastern  (Prox- 
imal Interphalangeal)  Joint. 

Anatomy. — The  ligaments  here  involved  are  the  four  vohir 
ligaments  described  by  Sisson^  as  follows:   "The  volar  ligaments 

>The  Anatomy  of  the  Domestic  Animal,  by  Septimus  Sisson,   S.   B.,   V.   S. 


130  LAMENESS  OF  THE  HORSE 

(Ligg  Volaria)i  consist  of  a  central  pair  and  a  lateral  and  me- 
dial bands  which  are  attached  below  to  the  posterior  margin  of 
the  proximal  end  of  the.  second  phalanx  and  its  complementary 
fibro-cartilage.  The  lateral  and  medial  ligaments  are  attached 
above  to  the  middle  of  the  borders  of  the  first  phalanx,  tlie  cen- 
tral pair  lower  down  and  on  the  margin  of  the  triangular  rough 
area." 

This  portion  of  the  inhibitory  apparatus  is  described  by 
Strangewaj^s'  Anatomy  as  two  posterior  ligaments  which  run 
each  from  three  points  on  the  sides  of  the  os  suffraginis  to  a 
piece  of  fibro  cartilage,  described  as  the  glenoid  cartilage,  and 
attached  to  the  postero-superior  edge  of  the  os  corouae ;  between 
them  is  the  insertion  of  the  inferior  sesamoidean  ligament. 

Etiolog-y  and  Occurrence. — Everything  tending  to  increase 

strain  upon  these  ligaments  is  contributory  to  possible  fibrillary 
fracture  of  these  structures.  Excessive  leverage  as  furnished 
by  long  toes,  long  toe-calks  and  low  heels  increases  the  normal 
tension  on  the  posterior  ligaments  of  the  pastern  joint.  Faulty 
conformation,  which  throws  an  abnormal  strain  on  these  liga- 
ments, is  a  predisposing  cause  of  inflammation  of  these  struc- 
tures. Hard  pulling  upon  slippery  and  rough  or  frozen  roads 
is  a  common  exciting  cause  of  this  injury.  The  condition  is  of 
comparatively  frequent  occurrence  and  is  seen  affecting  draft 
horses  frequently,  in  the  hind  legs. 

Symptomatolog-y.— Lameness  is  the  first  manifestation  of  this 
affection  and  weight  bearing  is  painful  in  direct  proportion  to 
the  extent  of  injury  present.  Volar  flexion  of  the  phalanges 
relieves  tension  on  the  parts ;  therefore,  this  position  is  assumed 
while  the  subject  is  at  rest.  When  considerable  tissue  has  been 
ruptured,  and  the  condition  is  very  painful,  the  foot  is  held  off 
the  ground  as  in  ail  painful  affections  of  the  extremity. 

By  palpation  evidence  of  pain  is  discernible,  though  very  little 
swelling  occurs.  Pain  is  increased  by  manual  tension  of  the 
parts  which  is  done  by  grasping  the  toe  of  the  foot  and  exerting 
traction  on  the  flexor  apparatus.  Care  must  be  taken  in  execut- 
ing such  manipulations,  and  it  is  only  by  comparison  of  the 
affected  member  with  the  sound  one  and  noting  the  difference 


LAMENESS   IN  THE  PORE  LEG  131 

in  the  manifestations  of  discomfort  that  we  may  arrive  at  the 
proper  conclusion. 

Some  hyperthermia  is  to  be  recognized  in  acute  inflammation, 
by  comparing  the  extremities.  In  the  fore  legs,  navicular  disease 
is  differentiated  by  noting  absence  of  contraction  at  the  heel. 
By  use  of  the  hoof  testers  one  may  recognize  evidence  of  inflam- 
mation of  the  navicular  apparatus.  In  inflannnation  of  the  pos- 
terior ligaments  of  the  pastern  joint,  there  is  also  absence  of  the 
characteristic  stuml)ling  which  is  seen  in  navicular  disease. 

Treatment. — Rest  is  the  first  requisite,  and  in  addition  every 
mechanical  means  possilile  to  change  the  center  of  gravity  in 
the  phalangeal  region,  is  to  be  employed.  This  is  best  accom- 
plished by  shortening  the  toe  and  paring  the  sole  at  the  toe  as 
much  as  conditions  will  permit.  The  heel  is  raised  by  means 
of  a  shoe  with  moderately  high  heel  calks. 

The  iodin-glycerin  combination  heretofore  mentioned  may  be 
ai)plied  and  the  parts  covered  with  cotton  and  bandage.  Sub- 
jects require  froin  three  weeks  to  several  months'  rest  and  must 
be  returned  to  work  carefully,  lest  the  incompletely  regenerated 
tissues  suffer  injury. 

Regeneration  of  tissue  in  such  cases,  as  has  been  pointed  out, 
is  slow  and  sufficient  time  for  complete  recovery  must  be  al- 
lowed or  relapses  will  occur. 

Fracture  of  the  First  2uid  Second  Phalanges. 

Etiology  and  Occurrence. — Fractures  of  the  first  phalanx 
(suffraginis)  occur  with  respect  to  frequency,  second  to  pelvic 
fractures.  Often,  almost  insignificant  injuries  cause  phalangeal 
fractures.  On  city  streets,  horses  shod  with  shoes  having  long 
calks  get  caught  in  frogs  of  street  railways  or  by  slipping  on 
rails,  and  phalangeal  bones  are  often  broken.  The  author  ob- 
served a  case  of  comminuted  fracture  of  both  the  first  and  sec- 
ond phalanges  (suffraginis  and  corona)  in  a  polo  pony  caused 
by  making  a  sudden  turn  while  in  action  in  a  contest  on  the  turf. 

Symptomatology. — Fracture  of  the  phalanges  is  nearly  al- 
ways signalized  l)y  lameness,  and  this  is  marked  during  the  pe- 
riod of  weight  bearing.     Lameness  is  usually  intense  and  where 


132  LAMENESS   OF  THE  HORSE 

the  pathognomonic  symptom  (crepitation)  is  not  recognized,  the 
intensity  of  the  chuidication,  when  other  causes  are  absent,  is 
indicative  of  fracture.  The  subject  does  not  bear  weight  upon 
the  affected  member  and  where  pain  is  intense,  the  foot  is  held 
in  an  elevated  position  and  swung  back  and  forth.  In  hind  legs 
the  member  is  often  flexed  in  abduction  and  held  in  this  position 
for  several  minutes,  being  rested  on  the  ground  only  during 
short  intervals.  When  compelled  to  walk,  if  pain  is  excruciating, 
the  animal  hops  with  the  sound  leg,  no  weight  being  supported 
liy  the  fractured  member. 

When  an  examination  of  the  subject  is  possible  before  the 
extremity  is  swollen,  crepitation  is  usually  found  without  great 
difficulty,  except  in  a  subperiosteal  break  or  in  some  eases  of 
vertical  or  oblique  fracture.  Great  care  is  necessary  in  handling 
the  injured  extremity  in  these  cases,  and  particularly  in  nerv- 
ous subjects  or  in  excited  animals  that  have  lieen  recently  in- 
jured in  runaways,  is  it  necessary  to  be  gentle  in  manipulating 
the  extremity,  if  definite  deductions  are  to  be  made.  As  has 
l)een  mentioned  in  the  chapter  on  diagnostic  principles,  if  the 
condition  is  so  painful  that  the  subject  does  not  relax  the  parts 
and  crepitation  is  masked,  local  anesthesia  is  necessary.  An 
anesthetic  solution  of  cocain  or  novocain  may  be  applied  to  the 
metacarpal  or  metatarsal  nerves  and  an  entirely  satisfactory 
examination  is  then  possible. 

Passive  movement  of  the  phalanges  in  all  directions  is  prac- 
tised in  order  to  produce  crepitation.  When  rotation  of  the 
parts  does  not  occasion  crepitation,  gentle  flexion  and  extension 
may  do  so.  And  in  many  instances,  consideral)le  manipulation 
of  the  i)halanges  is  necessary  before  the  pathognomonic  symptom 
is  to  be  recognized. 

In  eases  where  crepitation  is  not  found  and  lameness  is  pro- 
nounced, out  of  proportion  with  other  possible  existing  causes, 
one  may  by  exclusion  of  other  causes  establish  a  diagnosis  of 
fracture  in  the  course  of  forty-eight  hours.  In  the  meanwhile, 
support  is  given  the  affected  member  by  applying  an  effective 
leather  splint,  so  that  pain  may  ])e  diminished.  To  combat  in- 
flammation, a  suitable  cataplasm  may  l)e  applied  directly  to  the 
skin,  the  extremity  l)andaged,  and  the  temporary  immobilizing 


LAMENESS   IN  THE  PORE  LEG  133 

appliance  may  be  secured  over  all.  In  this  manner  one  niay 
make  repeated  examinations  of  the  subject,  and  if  slings  are 
used  and  every  other  necessary  precaution  taken  to  promote 
comfort  for  the  subject,  no  harm  will  result  in  delaying  for 
several  days  the  application  of  permanent  immobilization — ban- 
dages and  splints  or  casts.  In  fact,  where  much  swelling  exists 
at  the  time  one  is  called  to  treat  such  cases,  it  is  advisable  to  delay 
the  application  of  a  permanent  dressing  or  east  until  inflamma- 
tion has  somewhat  subsided. 

Course  and  Prognosis. — AVhere  conditions  are  favorable,  the 
nature  of  the  fracture  one  that  will  yield  to  treatment,  the  sub- 
ject not  aged,  and  facilities  for  giving  good  attention  to  the 
affected  animal  are  ample,  fractures  of  the  first  and  second 
phalanges  recover  completely  in  from  six  weeks  to  four  months. 
Only  simple  fractures  are  considered  curable  from  a  practical 
and  economical  point  of  view,  excepting  in  foals,  where  com- 
pound, and  even  comminuted,  fractures  may  be  so  handled  that 
animals  may  eventually  become  serviceable  though  blemished. 

Age  retards  the  process  of  osseous  regeneration,  but  in  one 
instance  at  the  Kansas  City  Veterinary  College,  a  very  aged 
mare  suffering  from  a  multiple  fracture  of  the  first  phalanx  was 
treated  and  at  the  end  of  sixty  days  was  able  to  walk  into  an 
aml)ulance.  Large  exostoses  had  developed  and  the  subject  re- 
mained lame,  but  union  of  the  broken  bone  took  place  in  a  sur- 
privsingly  prompt  and  effective  manner,  when  age  of  the  subject 
and  nature  of  the  fracture  are  considered. 

As  a  nde,  one  is  loath  to  reconnnend  treatment,  even  in  a  sim- 
ple transverse  fracture  of  the  first  phalanx,  in  animals  ten  years 
of  age  or  older.  The  conditions  which  exist  in  any  given  locality 
that  regulate  the  expense  of  caring  for  an  animal  during  the 
period  of  treatment,  especially  influence  the  course  to  be  pur- 
sued in  treating  fractures. 

Treatment. — For  permanent  immobilization  of  the  phalanges 
in  fracture,  materials  which  might  adapt  themselves  to  the  irreg- 
ular contour  of  the  member  and  at  the  same  time  contribute  suf- 
ficient rigidity   to   the   parts   without   doing  injury  to   the   soft 


134  LAMENESS  OF  THE  HORSE 

structures,  ^yould  coustitute  ideal  means  of  treatment;  but  no 
such  materials  have  yet  been  devised,  and  opinions  are  various 
as  to  the  most  efficient  and  practical  method  to  employ. 

After  the  fetlock  has  been  shorn  of  hair  and  the  ergot  trimmed, 
the  skin  is  thoroughly  cleansed  and  allowed  to  dry.  Several 
thin  layers  of  long  fiber  cotton  are  then  wrapped  around  the 
extremity — enough  to  pad  well  the  member — and  this  is  retained 
in  position  with  a  wide  bandage.  Gauze  bandages  are  prefer- 
able to  heavier  bandages  of  cotton  fabric  because  they  are  some- 
wliat  more  elastic  and  yield  to  the  irregular  contour  of  the  parts 
to  a  better  advantage.  Layers  of  three  inch  gauze  bandages, 
which  are  soaked  with  a  cold  starch  paste  are  wound  about  the 
extremity.  Strips  of  leather  that  are  flexible  and  not  more  than 
an  inch  in  width  are  placed  in  a  vertical  position  around  the 
leg  and  these  are  also  covered  with  the  starch  and  securely  held 
in  position  with  the  bandages.  In  this  way,  one  is  able  to  pro- 
vide a  sufficient  degree  of  rigidity  and  at  the  same  time,  where 
the  cast  is  carefully  applied,  little  if  any  injury  is  done  the  skin. 
Such  a  cast  is  not  difficult  to  remove  and  is  so  inexpensive  that 
it  may  be  removed  and  reapplied  at  any  time  it  should  be 
thought  preferable  to  do  so.  Of  course,  this  does  not  constitute 
an  effective  means  of  support  if  the  parts  are  to  be  frequently 
and  thoroughly  soaked  with  water,  but  animals  undergoing  this 
sort  of  treatment  are  usually  kept  sheltered. 

The  same  after-care  is  necessary  in  such  eases  as  is  given  in 
fractures  of  other  bones.  Two  months  after  the  injury  has 
been  done,  the  application  of  a  blistering  ointment  to  the  entire 
region  is  of  benefit. 

Results. — Much  depends  on  the  nature  of  fractures  as  to  the 
success  one  may  attain  in  approximating  the  parts  of  a  broken 
bone,  and  in  some  cases  of  oblique  fracture  for  instance,  com- 
plete recovery  is  impossible,  despite  the  most  skillful  and  pains- 
taking attention  given.  On  the  other  hand,  cases  of  simple 
transverse  fractures  make  perfect  recoveries  in  some  instances. 
All  fractures  are  serious,  and  in  every  instance  the  practitioner 
M'ould  best  be  careful  to  impress  his  client  with  the  many  diffi- 
culties which  usually  attend  the  treatment  of  fracture  in  horses. 


LAMENESS   IN  THE  FORE  LEG  135 

Tendinitis. 
Inflammation  of  the  Flexor  Tendons. 

One  of  the  most  eominon  causes  of  lameness  in  light  harness 
and  saddle  horses  is  tendinitis,  and  because  of  the  character  of 
the  structure  of  tendons  and  because  of  their  function,  an  active 
inflammation  of  these  parts  is  always  serious. 

Being  almost  inelastic  and  not  well  supplied  with  blood,  ten- 
dinous tissue  is  slowly  regenerated,  and  .so  much  time  is  required 
for  complete  recovery  to  take  place  in  tendinitis,  that  affected 
animals  seldom  fully  recover  before  they  are  in  service  or  vig- 
orously exercising  at  will.  As  a  result,  complete  recovery  is  de- 
layed or  prevented. 

The  extensor  tendons,  because  of  the  nature  of  their  function, 
are  very  seldom  strained ;  they  are  often  bruised  and  occasionally 
divided,  but  unlike  this  condition  in  the  flexors,  tendinitis  of 
the  extensors  is  of  rare  occurrence. 

For  a  concise  discussion  of  this  subject  the  most  practical 
classification  is  one  made  on  a  chronological  basis  and  we  may 
then  consider  tendinitis  as  acute  and  chronic. 

ACUTE  TENDINITIS. 

Etiology  and  Occurrence. — Causes  of  tendinitis,  as  in  almost 
all  diseases,  may  be  considered  under  the  heads  of  predisposing 
and  exciting.  Among  the  predisposing  causes  of  tendinitis  may 
be  mentioned,  faulty  conformation.  Everything  which  has  to 
do  with  increasing  the  strain  upon  tendons  adds  to  the  proba- 
bility of  their  being  over-taxed.  Long,  sloping,  pastern  bones; 
disproportionate  development  of  parts,  such  as  a  heavy  body 
and  small,  weak  tendons  and  long  hoofs,  are  the  principal  fac- 
tors which  usually  predispose  to  tendinous  sprains.  Degenera- 
tive changes  which  take  place  in  tendons  following  constitu- 
tional diseases  such  as  influenza  may  also  be  classed  as  a  predis- 
posing cause. 

Excessive  strain  when  put  upon  tendons  in  any  possible  man- 
ner, such  as  is  occasioned  in  running  and  jumping;  making  mis- 
steps and  catching  up  the  weight  of  the  body  with  one  foot,  when 
the  force  thus  thrown  upon  the  supporting  structure  is  great 


136  LAMENESS   OF  THE   HORSE 

because    of   monientiiin    gained    at    a    rai)id    j)aee,    are    exciting- 
causes  of  tendinitis. 

Symptomatolog-y. — In  all  cases  of  acute  tendinitis  there  is 
presented  a  characteristic  attitude  by  the  subject.  Volar  flexion 
in  a  sufficient  degree  to  relax  the  inflamed  structures  is  always 
evident.  The  foot  may  be  rested  on  the  toe  or  placed  slightly 
in  advance  of  the  one  supporting  weight,  l)ut  the  fetlock  is  al- 
ways thrown  forward.  More  or  less  swelling  of  the  inflamed 
tendons  is  present.  Where  the  deep  flexor  (perforans)  is  in- 
volved swelling  is  marked  and  with  swelling  there  is  present 
the  other  symptoms  of  inflammation — heat  and  supersensitive- 
ness. 

In  manipulating  tendons  for  the  purpose  of  detecting  super- 
sensitiveness,  care  must  be  taken  so  that  no  false  conclusion 
be  drawn,  because  of  the  aversion  many  horses  have  to  sul^nit- 
ting  to  palpation  of  the  tendons  even  when  they  are  in  a  normal 
condition. 

Supporting-leg-lameness  is  present  and  varies  in  degree  with 
the  intensity  of  the  pain  caused  by  weight  bearing.  In  many 
instances,  as  soon  as  the  subject  has  traveled  a  consideralile  dis- 
tance, lameness  diminishes  or  discontinues.  As  soon  as  the  af- 
fected animal  is  permitted  to  stand  long  enough  to  "cool  out" 
there  is  a  return  of  the  lameness,  which  is  then  marked. 

No  ditflculty  is  encountered  in  making  a  practical  diagnosis 
in  tendinitis ;  that  is,  one  may  fail  to  readily  recognize  the  ex- 
tent of  the  involvement  as  it  affects  the  superficial  flexor  tendon, 
for  instance,  but  this  has  no  {practical  liearing  on  the  prognosis 
and  treatment,  when  existing  inflannnation  of  the  deep  flexor  is 
recognized. 

The  course  of  each  tendon  is  readily  outlined  by  palpation ; 
all  ])arts  are  easily  manipulated ;  and  with  experience  one  may 
readily  i-ecognize  the  extent  and  degree  of  the  inflammation. 

Treatment. — In  some  cases  of  acute  tendinitis,  pain  is  intense 
and  Ihc  application  of  cold  i)acks  during  this  stage  is  very 
t)eneficial  in  that  ])ain  is  controlled  and  inflannnation  subsides. 
The  extremity  may  be  bandaged  with  a  liberal  quantity  of  ab- 
sor])ent  cotton  or  with  woolen  material.    Ice  water  is  then  poured 


LAMENESS   IN  THE  FORE  LEG  137 

around  the  bandaged  member  every  fifteen  minutes  and  this 
should  be  continued  for  al)Out  forty-eight  hours.  In  some  cases 
this  treatment  is  not  necessary  for  more  than  twelve  hours;  at 
the  end  of  this  length  of  time,  pain  has  subsided  and  the  acute 
stage  of  iiirtammation  has  passed  or  its  intensity  has  been  dimin- 
ished. 

Following  the  a]^plication  of  cold  packs,  the  use  of  a  poultice 
such  as  some  of  the  sterile,  medicated  muds,  is  of  marked  ben- 
efit. The  author  has  made  use  of  tincture  of  iodin  and  glycerin 
in  the  proportion  of  one  part  of  iodin  to  seven  parts  glycerin, 
with  very  satisfactory  results.  This  combination  is  hygroscopic, 
anodyne  and  antiseptic  and  is  easily  applied.  A  liberal  quan- 
tity is  directly  applied  all  around  the  affected  tendons  and  tlie 
leg  covered  with  a  heavy  layer  of  cotton,  and  this  is  snugly 
held  in  position  with  liandages.  The  application  may  be  used 
once  or  twice  daily,  or  if  it  is  thought  necessary,  an  attendant 
may  pour  a  quantity  of  the  iodized-glycerin  around  the  leg  and 
under  the  bandage  once  daily  without  removing  the  cotton  and 
bandage.    Needless  to  say,  absolute  rest  is  imperative. 

When  all  evidence  of  acute  inflammation  has  .subsided  vesica- 
tion is  indicated.  At  this  stasre  walking  exercise  is  beneficial 
and  tlie  subject  may  be  allowed  the  freedom  of  a  paddock. 

Some  practitioners  are  ]')artial  to  the  use  of  the  actual  cautery 
in  these  cases,  but  it  is  doubtful  if  it  is  necessary  to  produce 
such  a  great  degree  of  counter-irritation  in  cases  where  the  sub- 
ject is  suffering  the  first  attack  of  tendinitis. 

As  has  been  indicated,  ample  time  should  be  allowed  for  re- 
covery and  depending  upon  conditions,  it  takes  from  three  weeks 
to  six  months  for  cnniplete  recovery  to  become  established. 

Chronic   Tendinitis  and   Contraction   of  the   Flexor   Tendons. 

Etiolog'y  and  Occurrence. — Acute  inflammation  of  tlie  flexor 
tendons  may  result  in  chronic  tendinitis.  Recurrent  attacks  in 
cases  where  insufficient  time  is  allowed  for  complete  recovery 
to  result,  is  followed  by  chronic  inflammation  and  hypertrophy 
of  the  tendons.  Again,  in  subjects  where  conformation  is  faulty, 
no  amount  of  care  will  be  sufficient  to  prevent  a  recurrence  of 
the  inflammation  and  the  condition  must  become  chronic. 


13S 


LAMENESS  OF  THE  HORSE 


Symptomatology. — On  visual  examination  of  the  subject  at 
rest,  one  may  note  the  hypertrophied  condition  of  the  affected 
tendons.  Their  transverse  diameter  is  usually  perceptibly  in- 
creased and  in  many  cases,  there  is  an  increase  in  the  antero- 
posterior diameter.  The  latter  condition  causes  a  bulging  of 
the  tendon  that  is  so  noticeable,  because  of  the  convexity  thus 
formed,  it  is  commonly  known  as  "bowed  tendon." 

In  chronic  tendinitis  there  occurs  repeated  attacks  of  inflam- 
mation wherein  lameness  is  pronounced  and  there  exists  in  real- 


Fig.  20 — Contraction  of  tlie  superficial  digital  flexor  tendon  (perforatus)  of 
the  right  hind  leg,  due  to  tendinitis. 

ity,  at  such  times,  acute  inflammation  of  a  hypertrophic  struc- 
ture, where  at  no  time  does  inflammation  completely  subside. 
Therefore,  in  chronic  tendinitis  there  is  to  be  found  at  times  the 
same  conditions  which  characterize  acute  inflammation,  except 
that  there  is  usually  a  variance  of  symptoms  because  of  the  dif- 
ference in  the  degree  of  inflammation  and  pain. 

The  diagnosis  of  contraction  of  tendons  is  an  easy  matter  be- 
cause of  the  fact  that  relations  between  the  phalanges  are  con- 
stantly changed  with  tendinous  contraction.  If  one  bears  in 
mind  the  attachments  and  function  of  the  digital  flexors,  no 
difficulty  is  encountered  in  recognizing  contraction  of  either  ten- 
don. 


LAMENESS   IN  THE  FORE  LEG 


139 


Contraction  of  the  superficial  digital  flexor  (perforatus),  when 
nncomplieated,  is  characterized  by  volar  flexion  of  the  pastern 
joint.  The  foot  is  flat  on  the  ground  and  the  heel  is  not  raised 
because  tlie  superficial  flexor  tendon  does  not  have  its  insertion 
to  the  distal  phalanx  (os  pedis)  and  therefore  can  not  affect  the 
position  of  the  foot. 

By  causing  the  subject  to  stand  on  the  affected  member,  one 


Fig.  21 — Contraction  of  the  deep  flexor  tendon  (perforans)  of  the  riglit  hind 
leg,  due  to  tendinitis. 

may  outline  the  course  of  the  flexor  tendons  by  palpation,  and 
in  this  way  recognize  any  lack  of  tenseness  or  contraction  of 
tendons  or  of  the  suspensory  ligament. 

Contraction  of  the  suspensory  ligament  would  cause  the  pas- 
tern joint  to  assume  the  same  position  as  is  occasioned  by  con- 
traction of  the  superficial  digital  flexor  (perforatus)  tendon,  but 
when  the  subject  is  bearing  weight  on  the  affected  member,  it  is 
easy  to  determine  that  no  contraction  of  the  suspensory  liga- 


140 


LAMENESS  OP  THE  HORSE 


inent  exists,  by  noting  an  absence  of  abnormal  tenseness  of  this 
structure.  And  finall}^  contraction  of  the  suspensory  ligament 
is  of  rare  occurrence. 

Contraction  of  the  deep  flexor  tendon  (perforans)  causes  an 
elevation  of  the  heel.  The  foot  can  not  set  flat  because  the  in- 
sertion of  the  deep  flexor  tendon  to  the  solar  surface  of  the  distal 
phalanx  (os  pedis)  causes — when  the  tendon  is  contracted — a 
rotation  of  the  distal  phalanx  on  its  transverse  axis — hence  the 


Fig-.  22 — A  chronic  case  of  contraction  of  both  flexor  tendons  of  the  pha- 
langes. In  this  case  (presented  at  a  clinic  of  the  Kansas  City  Veterinary 
College)  because  of  long  continued  contraction  of  the  flexors,  which  pre- 
vented weight  being  supported  with  any  degree  of  comfort,  there  resulted  a 
partial  paralysis  of  the  extensors,  and  consequently  the  extremity  was 
dragged  on  the  ground. 

raised  heel.  No  other  tendon  has  this  same  effect  on  the  distal 
phalanx  and  the  condition  is  correctly  diagnosed  without  diffi- 
culty. 

Course  and  Complications. — This  condition  may  exist  for 
years  without  causing  the  subject  any  serious  inconvenience,  if 
the  affected  animal  is  kept  at  suitable  work.  In  other  instances 
recurrent  attacks  of  lameness  are  of  such  frequent  occurrence 
that  the  subject  is  not  fit  for  service.  Many  affected  animals 
that  are  kept   in  service  in  spite  of  lameness  (and  in  some  in- 


LAMENESS   IN  THE  FORE   LEG 


141 


stances  where  no  lameness  is  present),  soon  become  unservice- 
able because  of  contraction  of  the  inflamed  tendon.  This,  in 
fact,  is  the  condition  which  eventually  becomes  established  in 
most  instances. 

Treatment. — Where  conformation  is  not  too  faulty  so  that 
recovery  may  be  expected,  good  results  are  obtained  by  line- 
firing  the  tendons  and  allowing  the  subject  a  few  months'  rest. 


Fig.  23 — Contraction  of  the  superficial  and  deep  flexor  tendons   (perforatus 
and  perforans)  of  the  left  fore  leg. 

In  some  cases  median  neurectomy  is  advisable.  This  is  recom- 
mended by  Breton^  as  being  productive  of  good  results  even 
where  contraction  of  tendons  exists  and  tenotomy  is  done. 

By  shoeing  with  high  heel-calks  considerable  strain  is  taken 
from  the  inflamed  tendons  because  of  the  changed  position  of 
the  foot  which  alters  the  distribution  of  weight  on  different  parts 
of  the  leg.     Rubber  pads  materially  diminish  concussion   and 


^Traits  De  Therapeutique  Chirursicale  Des  Animaux  Domestique.   par  1'.  J. 
Cadiot  et  J.  Almy,  Tome  Second,  page  547. 


142  LAMENESS  OF  THE   HORSE 

should  be  made  use  of  when  the  subject  is  returned  to  work,  if 
the  character  of  the  work  is  such  as  to  occasion  much  concussion. 
It  is  to  be  remembered,  however,  that  in  sprains  there  occurs 
fibrillar}^  fracture  of  soft  structures  and  time  is  required  for 
regeneration  of  tissue  which  has  been  injured  or  destroyed.  Ab- 
solute rest  is  necessary  where  inflammation  is  acute  and  in  sub- 
acute or  chronic  tendinitis  avoidance  of  all  work  which  causes 
irritation  to  the  affected  tendons  is  imperative. 


Fig.  24 — Contraction  of  superficial  digital  flexor  and  slight  contraction  of 
deep  flexor  tendon. 

Where  contraction  of  tendons  exists  surgical  treatment  is  nec- 
essary. No  good  comes  from  appliances  which  are  calculated  to 
stretch  the  affected  tendons ;  in  fact,  they  aggravate  the  inflamed 
condition  and  hasten  complete  loss  of  function  of  the  affected 
member.  Where  there  exists  no  articular  or  ligamentous  dis- 
eases which  would  defeat  the  purpose,  tenotomy  is  the  only 
remedy  for  contracted  tendons. 


LAMENESS   IN  THE  FORE  LEG  143 

Contracted  Tendons  of  Foals. 

Etiology  and  Occurrence. — This  condition  is  occasionally  ob- 
served aiul  no  positive  explanation  of  the  reason  for  its  exist- 
ence can  be  given.  That  mal-position  en  utcro  causes  the  meta- 
carpal bones  to  develop  in  length  so  rapidly  that  the  tendons 
are  too  short,  is  an  explanation  that  is  offered.  Be  that  as  it 
may,  in  breeding  sections  of  the  country  the  general  practitioner 
is  obliged  to  handle  these  cases  and  successful  methods  of  treat- 
ment are  essential  even  though  cause  is  not  removable. 

Symptomatology. — The  superficial  flexor  tendon  (perforatus) 
alone,  is  the  one  usually  contracted,  and  while  both  flexors  are 
at  times  involved,  this  rarely  occurs.  The  condition  is  usually 
bilateral. 

The  degree  of  contraction  varies  greatly  in  different  cases. 
In  some,  contraction  exists  to  such  extent  that  it  is  impossi])le 
for  the  colt  to  stand,  and  because  of  continual  decubitus  where 
no  relief  is  given,  the  subject  is  lost  because  of  gangrenous  in- 
fection occasioned  by  bed  sores.  Otherwise  the  same  symptoms 
are  to  be  observed  in  this  condition,  that  exist  in  contraction  of 
tendons  of  the  mature  animal. 

Treatment. — "Wherever  contraction  is  not  too  marked  and 
weight  is  borne  with  the  affected  members,  and  where  the  feet 
can  be  kept  on  the  ground  in  a  nearly  normal  position,  it  is  pos- 
sible to  correct  the  condition  without  doing  tenotomy.  That  is, 
in  cases  where  the  subject  is  simply  "coek-ankled",  where  volar 
flexion  of  the  pastern  joint  exists  but  the  foot  is  kept  flat  on  the 
ground,  correction  is  possible  without  tenotomy. 

In  such  instances  the  foal  must  be  treated  early — before  the 
skin  on  the  anterior  pastern  region  has  been  badly  damaged  by 
knuckling  over.  It  is  possible  in  many  cases  to  stretch  the  flexor 
tendons  by  grasping  the  colt's  foot  with  one  hand,  and  with  the 
other  hand  one  may  push  the  pastern  in  the  direction  of  dorsal 
flexion.  This  may  be  tried  and  when  a  reasonable  amount  of 
force  is  employed,  no  harm  is  done,  even  though  no  material 
benefit  results.  Some  veterinarians  claim  good  results  from  this 
treatment  alone  and  direct  their  clients  to  repeat  the  stretching 
process  several  times  daily. 


144  LAMENESS  OF  THE  HORSE 

Whether  the  tendons  are  manually  stretched  or  not,  splints 
should  be  adjusted  to  the  affected  members.  The  legs  are  padded 
with  cotton  and  bandages  and  a  suitable  splint  is  applied  on 
either  side  of  the  members  and  securely  fixed  in  position  by 
bandaging. 

The  splints  are  kept  in  position  for  four  or  five  days  and  then 
removed  for  inspection  of  the  affected  parts.  If  necessary,  they 
are  reapplied  and  left  in  position  for  a  week;  however,  this  is 
unnecessary  in  the  average  case  that  is  treated  in  this  manner. 

"Where  contraction  exists  to  the  extent  that  the  subject  can 
not  stand  and  where  no  weight  is  borne  by  the  feet,  it  is  neces- 
sary to  divide  the  affected  tendons  surgically.  The  same  technic 
is  put  into  practice  that  is  employed  in  the  mature  subject  but 
there  is  much  greater  chance  for  a  favorable  outcome  in  the  foal. 
Further,  if  necessary,  one  may  divide  with  impunity,  both  ten- 
dons ou  each  leg,  at  the  same  time.  In  all  cases  this  operation 
is  done  by  observing  strict  aseptic  precautions  and  the  legs  are, 
of  course,  bandaged.  If  both  tendons  are  divided,  splints  should 
be  employed  and  kept  in  position  for  ten  days  or  two  weeks. 
Primary  union  of  the  small  surgical  wound  of  the  skin  and 
fascia  occurs  in  forty-eight  hours. 

The  reader  is  referred  to  William's  "Veterinary  Surgical 
and  Obstetrical  Operations,"  for  a  complete  description  of  this 
operation. 

In  veterinary  literature  there  is  occasionally  described  a  con- 
dition which  affects  young  foals  wherein  symptoms  similar  to 
those  of  contraction  of  the  flexors  are  manifested,  but  upon 
examination  it  is  found  that  rupture  of  the  extensor  of  the 
digit  (extensor  pedis)  exists.  This  affection  is  briefly  described 
by  Cadiot  but  no  complete  treatise  on  this  condition  has  been 
published. 

In  parts  of  Canada  foals  of  from  one  to  three  days  of  age 
are  found  affected  in  such  manner  that  more  or  less  interference 
with  the  gait  is  to  be  seen  in  those  moderately  affected.  There 
is,  in  some  subjects,  only  a  slight  impediment  in  locomotion 
which  is  occasioned  by  inability  to  properly  extend  the  digit. 
In  other  subjects,  while  able  to  stand  and  walk,  great  difficulty 
is  experienced  because  of  volar  flexion  of  the  phalanges.  The 
more  seriously  affected  animals  are  unable  to  stand  and.  in  most 
instances,  perish  because  of  the  effects  of  prolonged  decubitus. 


la:\ieness  in  the  fore  lec;  145 

A  local  enlargement  occurs  at  the  anterior  carpal  region  and 
the  mass  is  somewhat  tiuctuating,  extravasated  fluids  becoming 
infected  in  many  instances,  and  necrosis  of  the  skin  and  fascia 
provide  means  for  spontaneous  discharge  of  the  contents  of 
the  enlargement  if  it  is  not  opened.  The  infection  when  it 
becomes  generalized  causes  a  fatal  termination  in  most  cases  that 
are  not  treated. 


Fig.  25 — "Fish  knees." 

^Photo  by  Thos.   Millar,  SI.   R.   C.   V.   S. 

Native  stock  owners  of  some  parts  of  Canada  know  this  con- 
dition as  "fish  knees"  because  of  the  presence  of  the  ruptured 
end  of  the  extensor  tendon  which  is  found  coiled  in  the  cavity  of 
the  enlargements  caused  by  the  ruptured  tendon. 

Local  practitioners  have  treated  the  condition  by  incising  the 
swollen  mass  and  removing  the  part  of  tendon  contained  within 
such  cavities.  Treatment  has  not  proved  entirely  satisfactory 
in  the  majority  of  instances,  perhaps  because  of  tardy  inter- 
ference. 

In  a  colt's  leg  sent  the  author  by  .Mr.  Thoma.s  ]\Iillar,  Isl.  R. 
C.  V.  S.,  of  Asquith,  Saskatchewan,  a  careful  dissection  of  the 
carpal  region  revealed  the  fact  that  in  this  case  the  ruptured 
extensor  tendon  was  due  to  injury.  The  colt  may  have  been 
trampled  upon  by  its  dam  in  such  manner  that  the  tendon  was 
divided.  No  noticeable  evidence  of  injury  to  the  skin  was  to  be 
seen  on  its  outer  surface,  but  on  the  fascial  side  a  cyanotic  con- 
gested area,  which  was  situated  immediately  over  the  site  of  the 
ruptured  tendon,  was  very  evident. 


146 


LAMENESS  OF  THE  HORSE 


With  the  execution  of  a  good  surgical  technic,  the  ruptured 
tendon  might  be  sutured;  the  wound  of  the  tendon  sheath  as 
well  as  that  of  the  skin  carefully  united  by  means  of  gut  sutures, 
the  leg  bandaged  and  immobilized  with  lea,ther  splints  and  re- 
covery follow  in  a  reasonable  percentage  of  cases  so  treated. 
These  cases  afford  an  opportunity  for  the  perfection  of  practical 
means  of  treatment  by  those  who  frequently  meet  with  this  affec- 
tion. 

Rupture  of  the  Flexor  Tendons  and  Suspensory  Ligament. 

Etiology  and  Occurrence. — Rupture  of  the  flexor  tendons  or 
of  the  suspensory  ligament  is  of  rare  occurrence.  Frequently, 
these  structures  are  divided  as  the  result  of  wounds;  but  rup- 
ture, due  to  strain,  is  not  frequent. 


Fig.    26 — Extreme   dorsal  flexion   said   to   have   resulted   from   an   attack   of 
distemper.     From  Amer.  J'n'l.  Vet.    Med.,   Vol.   XI,   No.   4. 

In  some  cases  in  running  horses,  or  in  animals  that  are  put 
to  strenuous  performances,  such  as  are  jumpers,  rupture  of  ten- 
dons or  of  the  suspensory  ligament  takes  place.  However,  more 
frequently  this  follows  certain  debilitating  diseases  such  as  in- 
fluenza or  local  infectious  inflammation  of  the  parts  which  re- 
sults in  degenerative  changes  and  rupture  follows. 

The  non-elastic  suspensory  ligament  receives  some  heavy  strains 


LAMENESS   IN  THE  PORE  LEG  147 

during  certain  attitudes  which  are  taken  by  horses  in  hurdle 
jumping  as  is  explained  in  detail  by  Montane  and  Bourdelle^ 
under  the  description  of  this  ligament.  But  in  spite  of  the  fre- 
quent and  unusually  heavy  strains,  which  these  structures  re- 
ceive, complete  rupture  is  not  frequently  seen. 

Symptomatology. — AYhen  the  anatomy  and  function  of  the 
flexor  tendons  and  suspensory  ligament  is  thoroughly  under- 
stood, recognition  of  rupture  of  either  of  these  structures  is 
easily  recognized.  When  one  considers  that  in  rupture,  a  posi- 
tion directly  opposite  to  that  which  is  seen  in  contraction  in 
either  one  of  these  structures,  is  assumed,  a  detailed  description 
of  each  separate  condition  is  needless  repetition. 

However,  it  is  pertinent  to  suggest  that  rupture  of  the  deep 
flexor  tendon  (perforans)  allows  a  turning  up  of  the  toe. 
Whether  it  be  torn  loose  from  its  point  of  attachment  or  rup- 
tured at  some  point  proximal  thereto,  the  position  is  the  same 
— heel  flat  on  the  ground,  toe  slightly  raised  and  this  raising 
of  the  toe  varies  in  degree  as  the  subject  moves  al)out. 

AVhen  the  superficial  flexor  (perforatus)  is  ruptured  there  is 
no  change  in  the  position  of  the  foot  but  the  fetlock  joint  is 
slightly  lowered.  The  pathognomonic  symptom  is  the  lax  ten- 
don during  weight  bearing,  Avhich  may  l)e  felt  by  palpation  of 
the  tendon  along  its  course  in  the  metacarpal  region. 

With  complete  rupture  of  the  suspensory  ligament  there  oc- 
curs a  marked  dropping  of  the  fetlock  joint  and  an  alinormal 
amount  of  weight  is  then  thrown  upon  the  superficial  flexor  ten- 
don (perforatus),  causing  it  to  be  markedly  tensed.  This  is 
readily  recognized  by  palpation.  By  palpating  the  suspensory 
ligament  from  its  proximal  portion  down  to  and  beyond  its 
bifurcation,  while  the  affected  member  is  supporting  weight,  it 
is  possible  to  diagnose  rupture  of  one  of  its  branches. 

Prognosis  and  Treatment. — In  rupture  of  the  superficial 
flexor  tendon  (perforatus)  because  of  its  comparatively  less  im- 
portant function,  prognosis  is  favorable  and  recovery  takes  place 
when  proper  treatment  is  put  into  practice. 


lAnatomie  Regionale  Des  Animaux  Domestique,  page  695. 


148 


LAMENESS   OF  THE   HORSE 


With  rupture  of  the  deep  tiexor  tendou  (perforans),  especially 
wlien  it  occurs  at  or  near  its  point  of  insertion  and  sometimes 
foUowiug  disease,  prognosis  is  unfavorable. 

Rupture  of  the  suspensory  ligament  constitutes  a  condition 
which  is,  as  a  rule,  hopeless,  because  of  the  impracticability  of 
treating  such  cases. 

The  salient  feature  which  characterizes  any  practical  attempt 
at  treatment  of  ruptured  tendons  or  other  portions  of  the  inhibi- 
tory apparatus  of  the  fetlock  region,  is  to  retain  the  phalanges 
in  their  normal  position  for  a  sufficient  length  of  time  that  the 
approximated  ends  of  ruptured  tendons  or  ligaments  may  unite. 
The  length  of  time  required  for  this  to  occur,  together  with  the 


Fig.  27 — A  good  style  of  shoe  for  bracing  the  fetlock  where  tenotomy  has 
been  performed,  or  in  case  of  traumatic  division  of  the  flexor  tendons.  An 
invention  of  Dr.  G.   H.   Roberts. 


difficulties  encountered  in  confining  the  affected  extremities  in 
suitable  braces  or  supportive  appliances,  precludes  all  possibil- 
ity of  this  condition's  being  practically  amenable  to  treatment 
when  the  deep  flexor  tendon  (perforans)  and  suspensory  liga- 
ment are  simultaneously  ruptured.  It  does  not  follow,  even  so, 
that  recovery  does  not  succeed  treatment  in  some  of  these  un- 
favorable eases. 


J.AMEXESS   IN  THE  FORE  LEG  149 

Affected  subjects  are  kept  in  slings  as  long  as  it  seems  neces- 
sary— until  they  learn  to  get  up  without  deranging  the  braces 
worn. 

Several  styles  of  braces  are  in  use  and  each  has  its  objections ; 
nevertheless  some  sort  of  support  to  the  affected  member  is  neces- 
sary and  steel  braces  which  are  connected  with  shoes  are  usually 
employed. 

The  principal  difficulty  which  attends  the  use  of  braces  is 
pressure-necrosis  of  the  skin  which  is  caused  by  the  constant 
and  tirm  contact  of  the  metal  support.  The  practitioner's  in- 
genuity is  taxed  in  every  case  to  contrive  practical  means  of 
padding  the  exposed  parts  in  order  to  prevent  or  minimize  ne- 
crosis from  pressure.  This  is  attempted — with  more  or  less  suc- 
cess— by  frequent  changing  of  bandages  and  the  local  application 


Fig.   2H — Showing   the   Uolierts  brace  in  operation. 

of  such  agents  as  alcohol  or  witch  hazel.  Needless  to  say,  the 
skin  must  be  kept  perfectly  clean  and  the  dressings  free  from 
all  irritating  substances. 

The  fact  that  tendons  or  ligaments  which  are  ruptured,  do 
not  regenerate  as  readily  as  in  cases  where  traumatic  or  surgical 
division  occurs,  must  not  be  lost  sight  of,  and  prognosis  is  given 
in  accordance. 


150  LAMENESS  OF  THE  HORSE 

Thecitis  and  Bursitis  in  the  Fetlock  Region. 

Etiology  and  Occurrence. — Synovial  distension  of  tendon 
sheaths  and  bursae  in  the  region  of  the  fetlock  are  caused  by 
the  same  active  agencies  which  produce  this  condition  in  other 
parts.  The  fetlock  region  is  exposed  to  more  frequent  injury 
than  is  the  carpus  and  as  a  consequence  is  more  often  affected. 
The  same  proportionate  amount  of  irritation  affects  this  part 
of  the  leg,  owing  to  strains,  as  affect  the  carpus  from  a  similar 
cause;  and  synovitis  from  this  cause,  is  as  frequent  in  one  case 
as  in  the  other.  Therefore,  it  is  a  natural  sequence  that  the 
tendon  sheaths  of  the  metacarpophalangeal  region  are  frequently 
distended  because  of  chronic  synovitis  and  thecitis.  These  in- 
flammations are  usually  non-infective  in  character. 

The  cul-de-sac  of  the  capsular  ligament  of  the  fetlock  joint 
which  extends  upward  between  the  bifurcation  of  the  suspensory 
ligament  is  the  most  frequently  affected  structure  in  this  region. 
When  distended,  tM-'o  spheroidal  masses  bulge  laterally  and  an- 
terior to  the  flexor  tendons  in  a  characteristic  manner.  This 
condition  is  known  among  horsemen  as  "wind-gall"  or  "fet- 
lock-gall." 

The  sheath  of  the  flexor  tendons,  whieli  begins  about  the  mid- 
dle portion  of  the  lower  third  of  the  metacarpus,  and  continues 
downward  below  the  pastern  joint  is  often  distended. 

Excepting  in  cases  of  acute  inflammation  attending  synovitis 
of  these  parts,  no  lameness  marks  its  existence  and  in  chronic 
cases  of  synovial  distension  the  service  of  affected  animals  is  not 
interfered  with.  These  distensions  constitute  unsightly  blemishes 
and  they  are  treated  chiefly  for  this  reason. 

No  difficulty  is  encountered  in  recognizing  these  conditions 
even  where  considerable  organization  of  tissue  overlying  dis- 
tended thecae  occurs.  In  such  cases  there  may  be  only  slight 
fluctuation  of  the  enlargement,  but  if  necessary,  an  aseptic  ex- 
l)l()ratory  puncture  may  lie  nmde  with  a  suitable  needle  or  tro- 
car. 


LAMENESS  IN  THE  FORE  LEG  151 

Treatment. — Complete  rest  and  the  local  application  of  cold 
packs  are  in  order  in  acute  synovitis  when  there  is  distension  of 
tendon  sheaths.  In  the  fetlock  region,  because  of  the  ease  with 
which  pressure  may  be  employed,  the  parts  should  be  kept 
snugly  wrapped  with  cotton,  and  derby  bandages  are  used  to 
exert  the  desired  amount  of  pressure  over  the  affected  region. 
The  pressure-bandages  should  be  employed  as  soon  as  all  acute 
and  painful  inflammation  has  subsided ;  and  then  they  should  be 
continued,  day  and  night,  for  ten  days  or  two  weeks.     The  ban- 


Fig.  29 — Distension  of  tlieca  ni  tlic  rxlt-iisor  oi  llu-  iW-aW    U'xtensor  pedis). 

dages  should  be  removed  morning  and  night.  After  the  skin 
of  the  leg  has  thoroughly  dried  off,  an  infriction  of  alcohol  or 
distilled  extract  of  hamamelis  is  given  the  parts  and  the  cotton 
and  bandages  are  readjusted.  A  good,  even  and  firm  pressure 
in  such  cases  is  productive  of  satisfactory  results. 

In  chronic  distensions  of  tendon  sheaths  synovia  may  be  as- 
pirated and  about  five  cubic  centimeters  of  equal  parts  of  tinc- 
ture of  iodin  and  alcohol  is  injected  into  the  cavity.  This  is  not 
done,  however,  without  usual  aseptic  precautions.    If  no  marked 


152  LAMENESS   OF  THE   HORSE 

swelling-  results  within  forty-eight  hours  the  entire  fetlock  re- 
gion is  thoroughly  vesicated  and,  as  soon  as  the  skin  has  recov- 
ered from  the  effects  of  the  vesicant,  pressure  bandages  may  be 
employed.  In  these  cases,  subjects  may  be  put  into  service  after 
all  swelling  which  the  injection  or  the  vesicant  has  produced 
has  subsided.  The  pressure  liandages  are  used  at  night  or  during 
the  time  that  the  horse  is  in  its  stall  and  they  are  not  worn  by 
the  subject  while  at  work. 

Where  no  marked  swelling  occurs  within  ten  days,  as  the  re- 
sult of  the  injection  of  iodin,  the  injection  may  be  repeated  and. 
if  thought  necessary,  the  quantity  may  be  materially  increased. 
If  sw^elling  does  not  occur  it  is  indicative  that  no  particular  irri- 
tation has  been  caused. 

Some  swelling  is  desirable  and  much  swelling  sometimes  re- 
sults and  persists  for  weeks.  This  is  not  in  any  way  likely  to 
cause  permanent  trouble ;  and  if  the  technic  of  injection  is  skil- 
fully ('xecuted  no  infection  will  follow. 

By  persistent  and  careful  use  of  suitai)]e  elastic  bandages,  the 
support  thus  given  the  parts,  together  with  the  absorption  of 
products  of  inflammation  whicli  constant  pressure  occasions, 
some  chronic  cases  of  synovial  distension  of  tendon  sheaths  re- 
cover in  two  or  three  months  and  this  without  other  treatment. 
Such  good  results  are  not  to  be  expected  in  aged  subjects,  nor 
in  horses  having  at  the  same  time,  chronic  lymphangitis. 

Where  bandages  of  pure  rubber  are  employed  great  care  is 
necessary,  if  one  is  not  experienced  in  their  use,  lest  necrosis 
result.  W^here  bandages  are  unecmfoitabiy  tight  the  subject  will 
manifest  discomfort,  and  an  attendant  should  observe  the  animal 
at  intervals  for  a  few  hours  (where  there  may  be  some  doubt  as 
to  the  degree  of  pressure  which  is  exerted  by  elastic  bandages) 
and  readjustment  made  before  any  harm  is  done. 

Arthritis  of  the  Fetlock  Joint. 

Anatomy. — The  anatomy  of  the  metacarpophalangeal  arti- 
culation is  briefly  reviewed  on  page  58  under  the  heading  of 
"  Anntoino-Physiological  Review  of  Parts  of  the  Foreleg." 

Etiology  and  Occurrence. — The  chief  causes  of  non-infective 


LAMENESS   IN  THE  FORE  LEG 


153 


arthritis  of  the  fetlock  joint  are  irritations  from  concussion  and 
contusions  due  to  interfering.  The  condition  occurs  in  young 
animals  tliat  are  over-driven  in  livery  service  or  other  similar 
exhausting  work,  where  they  become  so  weary  that  serious  injury 
is  done  these  parts  by  striking  the  pasterns  with  the  feet — inter- 
fering. In  these  "leg-weary"  animals,  that  are  always  kept 
shod  with  fairly  heavy  shoes,  much  direct  injury  is  done  at  times 


Fig.   20— Rarefying  osteitis  whereir    articular  cartilage  was  destroyed  in   a 
case  of  arthritis  of  fetlock  joint. 

by  concussion  due  to  self-inflicted  blov/.s.  In  older  animals, 
where  there  exists  similar  conditions,  with  respect  to  their  being 
worn  from  fatigue  and,  in  addition,  periarticular  inflammatory 
organizations,  arthritis  is  not  of  uncommon  occurrence. 

Symptomatology. — In  true  arthritis  there  exists  a  very  pain- 
ful affection  which  is  characterized  by  manifestations  of  distress. 
The  subject  may  keep  the  extremity  moving  about — where  pain 
is  great — suspended  and  swinging.  There  is  sAvelling  which  is 
more  or  less  hot  to  the  touch  and  compression  of  the  parts  with 
the  fingers  increases  pain.  Lameness  is  always  pronounced  and 
no  weight  is  supported  witli  the  affected  member  in  very  acute 
and  generalized  arthritic  inflammations.     There  occurs  the  usual 


154  LAMENESS  OF  THE  HORSE 

facial  manifestations  of  pain — the  tense  condition  of  the  facial 
muscles  and  the  fixed  eye  and  nostril  are  in  evidence 

In  cases  Avhere  there  exists  a  synovitis  or  where  a  very  limited 
portion  of  the  articulation  is  involved,  a  somewhat  different  clin- 
ical picture  is  presented.  Then,  the  disturbance  causes  less  dis- 
tress; local  SM'elling  and  evidence  of  supersensitiveness  are  not 
so  pronounced  and  lameness  is  not  intense,  though  weight-bearing 
is  painful. 

Prognosis. — There  is  a  constant  difference  in  the  degree  of 
pain  manifested,  as  well  as  the  other  symptoms  of  inflammation, 
between  true  arthritis,  which  involves  much  of  the  joint,  and 
synovitis;  or  synovitis  plus  a  small  circumscribed  area  of  joint 
involvement.  This  difference  is  present  in  all  joint  affections 
of  the  extremities  and,  in  passing,  it  is  well  to  say  that  infection 
usually  increases  every  manifestation  of  pain.  Infection  occasions 
more  pronounced  local  symptoms  of  inflammation  and,  l)ecause 
of  the  rapid  progress  of  necrotic  destruction  of  cartilage,  the 
course  of  the  affection  is  usually  rapid;  ankylosis  is  a  frequent 
result  and  loss  of  the  subject  is  often  inevitable.  However,  in 
non-infective  arthritis  of  the  fetlock  joint,  prognosis  is  favor- 
able. 

Treatment. — The  same  general  principles  which  are  employed 
in  arthritis  of  other  joints  are  used  here.  Eest  and  comfort  for 
the  patient  is  sought  in  every  available  manner.  If  the  subject 
remains  standing  too  long,  the  sling  should  be  used  and  a  well- 
bedded  box-stall  will  contribute  much  to  the  comfort  of  the 
patient. 

Pain  and  acute  inflammation  is  diminished  or  controlled,  if 
possible,  by  using  ice-cold  packs.  In  nervous,  well-bred  animals 
analgesic  agents  may  be  employed;  or  small  doses  of  morphin 
sulphate — one  to  two  grains — given  at  intervals  of  three  hours 
during  the  first  stages  of  the  affection  is  very  beneficial.  This 
is  especially  indicated  in  infectious  arthritis. 

As  inflammation  subsides,  hot  applications  are  used  and  finally 
counter  irritants  are  employed.  Their  selection  is  a  matter  of 
choice  with  the  practitioner.  The  object  sought  is  the  same 
with  every  practitioner  and  while  methods  employed  vary,  re- 


LAMENESS   IN  THE  FORE  LEG  155 

suits  are  not  markedly  different  except  in  so  far  as  the  degree 
of  counter  irritation  which  is  produced  varies  in  given  cases. 
Where  a  great  degree  of  counter  irritation  is  thought  necessary, 
line-firing  with  the  actual  cautery  is  the  remedy  par  excellence. 

After-care.— In  the  course  of  three  or  four  weeks  subjects 
may  be  allowed  the  run  of  a  paddock  and,  after  a  complete  rest 
of  six  weeks  at  pasture,  they  may  be  returned  to  w^ork  with  care, 
if  the  work  is  not  of  a  nature  to  occasion  concussion  or  other 
manner  of  irritation  to  the  articulation. 

Neurectomy  is  not  indicated  even  though  there  is  a  recurrence 
of  lameness,  unless  the  lameness  is  not  pronounced  and  inflamma- 
tion is  periarticular  and  no  osseous  enlargements  mechanically 
interfere  with  function  of  the  joint.  There  are  few  cases  then, 
where  neurectomy  is  materially  helpful. 

Ossification  of  the  Cartilages  of  the  Third  Phalanx. 
(Ossification  of  the  Lateral  Cartilages.) 

Anatomy  and  Function  of  the  Cartilages. — Surmounting  each 
wing  of  the  distal  phalanx  (os  pedis)  is  the  irregularly-quad- 
rangular cartilage.  The  superior  border  of  this  cartilage  is  thin, 
generally  convex,  and  perforated  for  vessels  to  pass  to  the  frog ; 
the  inferior  border  is  attached  to  the  wing  of  the  third  phalanx 
and  posteriorly,  it  is  reflected  inward  and  is  continuous  with 
the  inferior  surface  of  the  sensitive  frog.  The  anterior  border 
which  is  directed  obliquely  downward  and  ])ackward  becomes 
blended  with  the  anterior  lateral  ligament  of  the  coffin  joint. 
The  fibrous  expansion  of  the  anterior  digital  extensor  (extensor 
pedis)  is  united  to  the  anterior  borders  of  the  lateral  cartilages. 

According  to  Smith^ :  These  structures  form  an  elastic  wall 
to  the  sensitive  foot,  and  attachment  to  the  vascular  laminae; 
they  also  admit  of  increase  in  width  occurring  at  the  posterior 
part  of  the  foot  without  destroying  the  union  of  the  two  set  of 
leaves.  Further,  by  their  connection  with  the  vascular  system 
of  the  foot,  their  elastic  movements  materially  assist  the  circu- 
lation. The  primary  use  of  the  lateral  cartilages  is  to  render 
the  internal  foot  elastic,  and  admit  of  its  change  in  shape  which 
occurs  under   the   influence  of  the   weight   of  the   body.     The 

^Manual  of  Veterinary  Physiology,  by  Major-General  F.  Smith,  C.  B., 
C.  M.  G.,  page  678. 


156 


LAMENESS  OF  THE   HORSE 


alteration  in  the  shape  of  the  foot  is  brought  about  by  pressure 
on  the  pad,  which  widens  and  in  consequence  presses  on  the  bars. 
The  pressure  received  by  the  pad  is  also  transmitted  to  the  plan- 
tar cushion,  which  likewise  flattens  and  spreads  under  pressure. 
Both  of  these  factors  force  the  cartilages  slightly  outwards. 
When  the  posterior  Avail  recoils  the  cartilages  are  carried  back 
to  their  original  position.  Should  the  elastic  cartilage  under 
pathological  conditions  become  converted  into  bone,  its  functions 
are  destroyed,  and  lameness  may  occur. 

Etiolog-y  and  Occurrence.— The  causes  of  ossification  of  these 
cartilages  are  several.  No  doubt  there  exists  a  predisposition 
to  this  condition  for  it  is  of  such  frequent  occurrence  in  heavy 


\^ 


/^*- 


Fig.   31 — Ring!)one  and   .sidebone. 


draft  types  of  horses.  Concussion  plays  an  important  role  and, 
according  to  Holler's^  theory,  which  is  sound,  high  heel  calks 
prevent  the  frog  from  contacting  the  ground,  and  as  weight  is 
placed  upon  the  foot  "the  lateral  cartilages  are  subjected  to  a 
continuous  inward  and  downward  dragging  strain." 

The  condition  affects  the  cartilages  of  the  fore  feet  more  fre- 
quently than  those  of  the  hind  and  the  outer  cartilage  is  more 
often  ossified  than  is  the  inner.  This  fact  may  be  accounted  for 
by  its  more  exposed  position  ;  it  is  also  frequently  injured  by 


'Moller's  Regional  Veterinary  Surgery,  by  Dollar,  page  630. 


LAMENESS   IN  THE  FORE  LEG  157 

being  trampled  upon  and  otherwise  contused  or  cut,  as  in  lacer- 
ated wounds  of  the  quarter. 

Symptomatology. — Ossification  of  tlie  cartilages  is  known  by 
grasping  the  free  borders  with  the  fingers  and  attempting  their 
flexion ;  the  rigid  inflexible  ossified  cartilage  is  thus  easily  recog- 
nized. 

Lameness  during  weight-bearing  occurs  in  the  majority  of 
cases  at  some  time.  Much  depends  on  the  conformation  of  the 
foot  and  whether  the  involvement  affects  one  or  both  cartilages 
as  to  the  degree  and  duration  of  lameness  which  marks  this 
affection.  In  narrow  and  contracted  heels  it  is  reasonable  to 
expect  more  lameness  than  in  well  formed  feet.  "Where  only 
one  cartilage  is  ossified,  the  other  being  flexible,  there  is  less  in- 
convenience experienced  by  the  subject  during  weight-bearing, 
because  of  the  expansion  of  the  heel  which  the  one  normal  carti- 
lage allows. 

Treatment. — There  is  little  if  anything  to  be  done  in  case  the 
cartilage  ha.s  become  ossified  except  to  shoe  without  high  calks 
but  preferably  with  rubber  pads.  The  hoof  should  be  kept 
moist;  the  wall  at  the  quarter  may  be  rasped  thin  and  kept 
anointed.  Firing  is  of  no  practical  benefit  in  these  cases,  and 
it  is  doubtful  if  vesication  is  helpful  excepting  where  only  a  part 
of  the  cartilage  is  ossified. 

Subjects  which  continue  somewhat  lame,  because  of  complete 
ossification  of  both  cartilages,  are  best  put  to  slow  work  on  soft 
ground  and  not  driven  on  pavements. 

Navicular  Disease. 

This  more  or  less  ambiguous  term  has  been  applied  to  various 
diseases  affecting  the  structures  which  make  up  the  coffin  joint. 
"We  consider  this  name  to  be  applicable  to  inflammatory  involve- 
ment of  the  third  sesamoid  (navicular  bone),  the  deep  flexor 
tendon  (perforans)  and  the  bursa  podotroehlearis  or  navicular 
bursa. 

Etiology  and  Occurrence. — In  1804  Thomas  Greaves^  wrote 
on  the  subject  of  navicular  disease  as  follows:  "The  opinion  I 


^Edinburgh  Veterinary  Review,  Vol.  VI,  page  616 


158  LAMENESS  OF  THE   HORSE 

entertain  upon  the  suhjeet  of  navicular  disease  is.  that  in  by 
far  the  greater  majority  (if  not  all)  of  these  cases  there  exists 
in  the  animal  affected  a  congenital  tendency  or  predisposition, 
that,  generally  speaking,  it  is  the  high  stepper,  the  good  goer, 
that  becomes  the  victim  to  this  disease ;  and  it  is  a  fact  well  at- 
tested, that  it  as  frequently  develops  itself  in  the  feet  with  wide 
frogs,  bulbous  heels,  shallow  heels,  spread  flattisli  feet,  as  in  the 
narrow  upright  feet.  .  .  .  T  have  known  foals,  born  from  de- 
fective parents,  in  wliicli  this  condition  was  so  strongly  devel- 
oped, that  all  men  would  at  once  pronounce  them  affected  with 
navicular  disease,  a^'-d  such  lameness  was  permanent." 

Often  both  fore  feet  are  affected  and  this  would  point  toward 
its  being  a  disease  wherein  either  conformation  or  congenital 
tendencies  exists.     It  is  rare  that  hind  feet  are  involved. 

There  are  many  theories  regarding  the  possible  exciting  causes 
of  navicular  disease  and,  when  one  has  carefully  considered  the 
explanations  as  offered  by  Peters,  INIoller,  Branell,  Schrader  and 
others,  he  may  conclude  that  navicular  disease  is  a  non-infectu- 
ous  intlammatory  affection  of  the  third  sesamoid  (navicular) 
bone,  deep  flexor  tendon  (perforans)  and  adjoining  structures. 
"Whether  it  originates  in  the  flexor  tendon  or  whether  the  bone 
is  the  original  part  affected,  the  disease  is  freciuently  met,  and 
of  all  possible  causes,  jars  and  irritation  incident  to  concussion 
of  travel,  are  pro])ably  the  princij^al  causative  agents. 

Symptomatology. — Lameness  is  the  primary  indicator  and  a 
constant  sym])t()m  which  attends  navicular  disease  wherever 
much  structui-al  change  aff(M'ts  the  infirm  ])arfs.  As  the  degree 
of  intensity  or  extent  varies,  so  is  there  a  dissimilarity  in  the 
character  of  the  impediment.  Incipient  cases  of  bilateral  in- 
volvement are  more  difficult  to  diagnose  than  are  unilateral  af- 
fections, particulai'ly  when  lameness  is  not  marked.  There  is 
manifested  a  sui)i)orting-leg-lameness  which  varies  as  to  degree 
in  tlie  same  subject  at  different  times.  This  may  be  noticed  dur- 
ing the  same  ti-ip  in  an  animal  tluit  is  lieing  driven.  There  is 
a  tendency  for  the  subject  to  stumble  and,  of  course,  where  the 
affection  is  bilateral,  there  is  a  stilted  gait  owing  to  shortened 
strides. 


LAMENESS   IN  THE   FORE  LEG  159 

At  rest  the  lame  animal  usually  points  with  the  afifected  mem- 
ber. Because  of  the  fact  that  the  distance  is  lessened  between 
the  origin  and  insertion  of  the  deep  flexor  tendon  (perforans) 
by  this  attitude,  one  may  readily  understand  the  reason  for  the 
position  assumed  by  the  subject.  Pressure  on  the  navicular  bone 
is  diminished  and  tension  on  the  flexor  tendon  is  relieved  by 
even  slight  volar  fiexion. 

In  acute  inflammatory  affections  abnormal  heat  may  be  de- 
tected ill  the  region  of  the  heel.  By  exerting  tension  on  the 
flexor  tendon,  by  means  of  passive  dorsal  flexion  of  the  member, 
evidence  of  hyperesthesia  may  be  detected.     With  the  hoof  test- 


Fig-.  32 — "Pointing"' — the  position  as.sumed  by  horse  havirg  unilateral  navic- 
ular disease. 

ers  one  may  determine  supersensitivenss  in  most  instances.  There 
occurs  more  or  less  contraction  of  the  hoof  in  navicular  disease, 
but  this  is  not  to  be  taken  as  a  cause  of  the  affection,  but  rather 
a  sequence. 

In  some  cases  of  unilateral  navicular  disease  there  is  a  marked 
contrast  in  size  between  the  sound  and  unsound  foot.  HowcAcr, 
one  must  not  be  misguided  in  this  particular,  for  in  some  pairs 
of  sound  feet  there  exists  considerable  difference  in  size.  Finally, 
by  a  change  from  the  normal  position  of  the  foot  to  one  in  which 
the  heel  .is  somewhat  elevated  (as  may  be  obtained  by  shoeing 
witli   big  1   heel  calks),   relief  is  evident,   and  in   the  opposite 


160  LAMENESS  OF  THE  HORSE 

position,  the  condition  is  aggravated.  This  experiment  may  be 
used  for  diagnostic  purposes. 

Treatment. — When  the  anatomy  of  the  diseased  parts  is 
taken  into  consideration,  and  an  analysis  of  the  lesions  which 
occur  in  cases  where  considerable  structural  change  is  occasioned 
by  this  affection,  it  is  obvious  that  recovery  is  impossible.  Only 
in  eases  where  the  inflammation  is  promptly  cheeked  before 
damage  has  been  done  the  navicular  bone  or  the  flexor  tendon, 
is  permanent  recovery  possible.  The  disease  is  not  frequently 
treated  during  this  stage,  however,  and  in  the  majority  of  in- 
stances the  condition  becomes  chronic. 

As  soon  as  a  diagnosis  is  made  the  shoes  must  be  removed,  the 
toe  shortened  with  the  hoof  pincers  and  rasp  and  the  subject  is 
put  in  a  well  bedded  box-stall.  If  the  animal  is  very  lame  and 
the  inflammation  is  acute,  ice-cold  packs  should  be  applied  to 
the  feet.  As  soon  as  acute  inflammation  has  subsided  the  foot 
may  be  so  pared  that  all  excess  of  sole  and  frog  is  removed  with- 
out lowering  the  heels,  and  the  animal  may  be  blistered  about 
the  coronet  region.  The  subject  may  be  shod  later,  with  heel 
calks  that  raise  the  heel  moderately  and  a  protracted  period  of 
rest  should  be  enforced. 

Tn  cases  where  no  acute  inflammatory  condition  exists,  neurec- 
tomy is  beneficial.  One  must  discriminate,  however,  between 
favorable  and  unfavorable  subjects.  This  is  not  a  last  resort 
expedient  to  be  employed  in  cnses  where  extensive  lesions  of  the 
navicular  structures  exists.  With  proper  shoeing,  and  by  put- 
ting the  subject  at  suitable  work,  where  concussion  of  fast  travel 
on  hard  roads  is  not  necessary,  the  best  results  are  obtainable. 

Laminitis. 

This  disease  is  primarily  a  non-infective  inflammation  of  the 
sensitive  laminae  which  very  frequently  affects  the  front  feet. 
Often  all  four  feet  are  affected,  less  frequently  one  foot  (when 
its  fellow  is  unable  to  sustain  weight)  and  rarely  the  hind  feet 
alone. 

Occurrence.— Probably  a  greater  number  of  cases  of  laminitis 
occur  in  localities  where  horses  that  are  worked  on  heavy  trans- 


LAMENESS   IN  THE  FORE  LEG  161 

fer  wagons  are,  when  in  a  state  of  perspiration,  allowed  to  stand 
exposed  to  sudden  lowering  of  temperature  and  to  stand  in  a 
cool  or  cold  shower  of  rain  such  as  occurs  near  the  coast  of  the 
Great  Lakes  or  the  ocean  in  some  parts  of  this  country. 

This  disease  occurs  in  connection  with  digestive  disorders  of 
various  kinds  and,  because  of  the  frequent  association  of  the 
two  conditions,  the  common  term  "founder"  has  long  been  em- 
ployed to  designate  laminitis.  In  cases  of  "over-loading,"  par- 
ticularly when  a  large  quantity  of  wheat  has  been  eaten  by 
animals  that  are  unaccustomed  to  this  diet,  laminitis  almost  con- 
stantly results. 

Large  draughts  of  cold  water,  when  drunk  by  animals  that 
are  overheated  is  often  followed  by  laminitis.  Concussion,  such 
as  attends  hard  driving,  especially  in  unshod  horses  or  on  rough 
and  hard  roads,  is  often  succeeded  by  this  affection.  Likewise,  as 
has  been  stated,  injury  such  as  is  occasioned  by  long  continued 
standing  on  the  same  foot  is  followed  by  laminitis.  Some  horses 
that  are  frequently  shod,  suffer  from  this  affection  a  few  hours 
after  shoes  have  been  reset.  Dr.  Chas.  R.  Treadway  of  Kansas 
City  reports  the  rather  frequent  occurrence  of  such  conditions 
in  horses  that  are  in  the  fire  department  service  in  his  city. 

Age  in  no  way  influences  the  occurrence  of  laminitis  and  the 
general  condition  of  an  animal  with  regard  to  its  vigor  or  state 
of  flesh  has  no  apparent  influence  toward  predisposiag  horses  to 
this  ailment. 

Etiology  and  Classification. — As  it  is  with  some  other  dis- 
eases, one  may  unprofitably  theorize  on  cause  and  readily  enu- 
merate many  conditions  which  are  apparently  contributory 
toward  producing  the  affection.  Causes  may  well  be  grouped, 
however,  and  a  more  definite  understanding  of  laminitis  is  pos- 
sible as  a  result.  Such  collocation  would  include  conditions 
which  directly  or  indirectly  affect  the  digestion,  such  as  puer- 
peral laminitis,  drinking  of  large  quantities  of  cold  water  and 
exposure  to  cold  and  rain  when  the  body  is  warm.  All  of  these 
various  conditions  might  be  said  to  affect  the  vaso-constrictor 
nerves  in  such  manner  that  the  natural  tendency  (because  of  the 
peculiar  structure  of  the  sensitive  laminae  and  their  mode  of 


162  LAMExNESS  OF  THE  HORSE 

attachment  to  the  non-sensitive  wall)  which  solipeds  have  for 
this  affection  is  indirectly  due  to  this  one  cause — vaso-constric- 
tion.  According  to  Dr.  D.  ]\I.  Campbell,  the  eft'ect  of  toxic  ma- 
terials, which  may  be  absorbed  from  the  digestive  tract  or  the 
uterus  in  parturient  females,  upon  the  vaso-constrictor  nerves, 
is  such  that  a  passive  congestion  of  the  sensitive  laminae  occurs 
and  laminitis  is  the  result.  He  believes  that  even  the  chilling 
of  the  surface  of  the  body  when  very  warm,  by  a  cold  rain,  con- 
stitutes a  condition  wherein  the  effect  upon  the  vaso-constrictors 
is  the  same. 

This  grouping  does  not  include  the  effect  of  direct  injuries  of 
any  and  all  kinds  to  which  the  feet  are  subjected  such  as : 
Concussion  in  fast  road  work,  injuries  occasioned  by  tight  or 
ill  fitting  shoes,  contusions  of  any  kind  resulting  in  non-infec- 
tious inflammation  of  the  sensitive  laminae,  as  well  as  the  causes 
which  produce  laminitis  where  weight  is  borne  by  one  foot  when 
its  fellow  is  out  of  function. 

A  classification  which  is  practical  is  that  of  aciiie  and  chronic 
laminitis.  To  the  practicing  veterinarian  it  is  this  manner 
of  consideration  that  i.s  essential  in  the  handling  of  these  cases. 

Symptomatology. — In  the  acute  attack  the  condition  is  so 
well  described  by  Dr.  R.  C.  Moore^  that  we  quote  him  in  part  as 
follows : 

The  acute  form  is  generally  ushered  in  very  suddenly.  Often 
a  horse  that  is  perfectly  free  from  symptoms  of  the  disease  is 
found  a  few  hours  later  so  stiff  and  sore  that  he  will  scarcely 
move.  They  stand  like  they  were  riveted  to  the  ground.  If 
forced  to  move  the  evidence  of  pain  subsides  to  some  extent  after 
they  have  gone  a  short  distance,  to  return  more  severe  than  ever 
after  they  have  been  allowed  to  stand  for  a  short  time.  If  the 
disease  is  confined  to  the  two  front  feet,  the  hind  feet  are  placed 
well  under  the  center  of  the  body  to  support  the  weight  and 
the  front  ones  are  advanced  in  front  of  a  perpendicular  line  so 
as  to  lessen  the  weight  they  must  bear.  If  they  are  made  to 
move,  the  same  position  of  the  feet  is  maintained.  If  made  to 
turn  in  a  small  circle,  they  do  so  by  using  the  hind  feet  as  a 
pivot,  bringing  the  front  parts  around  l)y  i:>lacing  as  little  weight 
on  them  as  possible. 

Placing  the  hind  feet  so  far  under  the  body,  arches  the  back 

■<      !« 

^Kquine  Laminitis  or  Pododermatitis,  by  R.   C.   Moore,  D.   V.   S.,   American 
Journal  of  Veterinary  Medicine,  Vol.   XT,  page  284. 


LAMENESS   IN  THE   FORE  LEG  163 

and  often  leads  to  errors  in  diagnosis,  the  condition  sometimes 
being  taken  for  diseases  of  the  loins  or  kidneys. 

If  all  four  feet  are  involved,  the  animal  stands  in  the  usual 
position  assumed  in  health,  but  if  urged  to  move,  the  least  effort 
to  do  so  usually  brings  on  chronic  spasms  of  the  entire  body.  In 
very  severe  cases,  a  slight  touch  of  the  hand  will  develop  the 
spasms.  At  times  they  are  so  severe,  and  have  such  short  inter- 
missions, that  the  disease  has  been  mistaken  for  tetanus.  How- 
ever, the  clonic  nature  of  the  spasm  should  prevent  such  an 
error.  If  tli-y  are  lying  down,  it  is  difficult  to  get  them  to  arise, 
and  if  they  do  so,  they  show  marked  symptoms  of  pain  for  some 
time  after  rising. 

If  the  disease  is  confined  to  the  hind  feet,  they  are  placed 
well  forward  to  relieve  the  strain  on  the  toe  caused  by  the  down- 
ward pull  of  the  perforans  (deep  flexor)  tendon,  but  in  place  of 
the  front  feet  ])eing  kept  in  front  of  a  perpendicular  line,  as  they 
are  when  the  disease  is  confined  to  the  front  ones,  they  are  placed 
far  back  under  the  body,  so  they  will  carry  the  maximum  share 
of  the  body  weight  of  which  they  are  capable.  The  position  of 
the  feet  is  of  great  importance  and  offers  symptoms  that  should 
not  be  overlooked. 

Wlien  the  subject  is  caused  to  walk,  symptoms  of  excruciating 
pain  are  manifested  in  all  acute  cases  of  laminitis.  In  some  cases 
where  all  four  feet  are  affected,  no  reasonable  amount  of  per- 
suasion will  cause  the  suffering  animal  to  move  from  its  tracks. 
There  is  acceleration  of  the  rate  of  heart  action;  the  pulse 
is  full  and  in  some  cases,  bounding.  As  the  affection  progresses 
the  pulse  becomes  rather  weak  and  irregular.  The  character  of 
the  pulse  in  the  region  of  the  extremity  is  a  reliable  indicator; 
but  one  has  to  learn  to  make  necessary  discrimination  because 
of  the  condition  of  the  parts,  as  in  some  cases  of  lymphangitis 
or  where  the  skin  is  abnormally  thick.  The  characteristic  throb- 
bing pulse  is,  however,  easily  recognized  in  most  cases.  Tem- 
perature is  variable,  though  usually  elevated  from  one  to  four 
degrees  above  normal.  This  symptom  varies  with  the  type  and 
stage  of  the  affection.  In  a  subject  tliat  has  been  down,  unable 
to  rise  for  several  days,  where  there  is  a  suppurative  and  slough- 
ing condition  of  the  laminae,  the  temperature  is  high.  Whereas, 
in  some  other  and  less  destructive  cases  there  may  be  little 
thermic  disturbance  after  the  first  few  hours  have  lapsed. 

A  constant  symptom  in  liilateral  affections  of  acute  laminitis 


164  LAMENESS  OP  THE  HORSE 

is  the  difficulty  with  which  the  subject  supports  weight  with 
one  foot.  It  is  this  which  causes  the  victim  to  stand  as  if 
"rooted  to  the  ground"  when  all  four  feet  are  involved.  If  one 
attempts  to  take  up  one  foot,  thus  causing  the  subject  to  stand 
on  the  other,  there  is  much  resistance  and  in  many  eases  the 
animal  refuses  to  give  the  foot. 

When  we  consider  that  the  sensitive  parts  of  the  foot  are 
encased  by  a  horny,  unyielding  box  and  that,  when  the  laminae 
are  congested,  a  great  pressure  is  brought  to  bear  upon  the  sensi- 
tive structures,  it  is  easy  to  understand  why  the  condition  is  so 
painful. 

Chronic  laminitis  is  a  sequel  of  acute  inflammation  of  the  sensi- 
tive laminae.  It  varies  as  to  intensity  and  the  exact  manner 
of  its  manifestation   depends  upon  preexisting  disturbances. 

In  some  mild  cases  of  laminitis  there  are  recurrent  attacks 
wherein  no  particular  structural  change  exists,  and  diagnosis 
is  established  chiefly  by  noting  the  character  of  the  pulse  at  the 
bifurcation  of  the  large  metacarpal  (or  metatarsal)  artery  just 
above  the  fetlock.  The  same  manifestation  of  pain  is  present 
when  weight  is  supported  by  one  foot,  though  in  a  lesser  degree. 
There  is  less  local  heat  to  be  detected  by  palpation  than  in 
the  acute  cases. 

Chronic  laminitis  as  it  occurs  following  acute  attacks  which 
have  resulted  in  structural  changes  of  the  foot,  present  the  same 
symptoms  just  described  and,  in  addition,  the  j^eculiar  altera- 
tions in  structure  exist.  When,  owing  to  acute  inflammation  of 
the  sensitive  laminae,  there  has  resulted  necrosis  of  this  sensitive 
tissue  together  with  infiltration  between  the  anterior  surface  of 
the  distal  phalanx  (os  pedis)  and  the  contacting  hoof,  the  lower 
portion  of  the  distal  phalanx  is  turned  downward  and  backward 
(rotated  upon  its  transverse  axis).  Because  of  the  traction 
which  is  exerted  by  the  deep  flexor  tendon  (perforans),  as  it 
attaches  to  the  solar  surface  of  the  distal  phalanx,  this  rotation 
is  facilitated.  With  hyperplasia  of  lamina,  at  the  anterior  por- 
tion of  the  distal  phalanx,  there  results  a  thick  "white  line." 
Rotation  of  the  distal  phalanx  necessitates  a  descent  of  its  apical 
portion  and  there  occurs  a  "dropped  sole." 


LAMENESS   IN  THE  FORE  LEG  165 

In  time,  partly  because  of  excessive  wear  of  hoof  at  the  heel, 
owing  to  an  altered  condition  in  the  normal  antagonistic  rela- 
tion between  the  flexor  and  extensor  tendons,  the  toe  makes  an 
excessive  growth,  and  the  concavity  of  the  anterior  line  is  ac- 
centuated owing  to  this  abnormal  length  of  hoof.  The  hoof, 
because  of  recurrent  inflammator}^  attacks,  is  corrugated — eleva- 
tions of  horn  in  parallel  rings  are  usually  present. 

Aniiuals  that  are  so  affected  in  traveling  strike  the  heel  first 


Fig.   33— The  hoof  in  chronic  laminitis.     Note  the  concavity.     This  animal 
was  serviceable  for  any  worlv  that  could  be  performed  at  a  walk. 

and  the  toe  is  later  contacted  with  the  ground  surface.  Rotation 
of  the  distal  phalanx  upon  its  transverse  axis  produces  a  con- 
dition, with  respect  to  this  peculiar  impediment,  that  is  equiva- 
lent to  added  and  excessive  length  of  the  deep  flexor  tendon. 

Where  there  occurs  suppuration,  by  careful  inspection  of  the 
coronary  region,  one  may  early  recognize  detachment  of  hoof. 
In  such  cases  animals  remain  recumbent  and,  while  the  condi- 
tion is  not  so  painful  at  this  stage,  the  practitioner  must  not 
overlook  the  real  state  of  affairs.  History,  if  obtainable,  will 
be  a  helpful  guide  in  such  cases.     Separation  of  hoof  occurs  as 


166 


LAMENESS  OF  THE  HORSE 


a,  rule  in  from  four  to  ten  days  after  the  initial  attack  of  acute 
laminitis.  Needless  to  say  these  cases  are  hojieless,  when  the 
economic  phase  of  handling  subjects  is  considered. 

Treatment. — Much  depends  upon  the  concomitant  disturb- 
ances (or  causes  if  one  is  justified  in  referring  to  them  as  such) 
as  to  the  manner  in  which  laminitis  is  to  be  treated.  In  all  cases 
where  digestive  disturbances  exist,  the  prompt  unloading  of  the 


Fig.   34 — Showing  the  effects  of   laminitis.      By  permission,   from   Merillat's 
"Veterinary  Surgical  Operations." 

contents  of  the  alimentary  canal  is  certainly  indicated.  D.  M. 
Campbell^  in  a  discussion  of  laminitis  has  the  following  to  say 
regarding  the  treatment  of  such  cases : 

Because  superpurgation  may  be  followed  by  laminitis,  the  ad- 
visa))ility  of  using  the  active  hypodermic  cathartics  is  questioned. 
Neither  arecolin  nor  eserin  can  cause  superpurgation.  The  action 
of  the  former  does  not  continue  longer  than  an  hour  after  ad- 
ministration and  of  the  latter  not  more  than  eight  hours.  The 
action  of  either  is  mild  after  the  first  few  minutes. 

I  do  not  think  that  anyone  has  recommended  either  arecolin 
or  eserin  where  there  is  severe  purgation.  Where  the  intestinal 
canal  is  fairly  well  emptied  and  its  contents  fluid,  I  should  be 
inclined  to  rely  ujion  intestinal  antiseptics  to  hold  in  check  harm- 
ful bacterial  growth. 


^American   Journal   of   Veterinary   Medicine,    Vol.    XI,    page   .318. 


LAMExNESS   IN  THE  FORE  LEG  167 

Tlie  use  of  aliiiii  in  the  treatment  of  laminitis  is  held  to  be  with 
out  reason  other  than  the  empirical  one  that  it  is  beneticial.  If 
laminitis  is  due  chiefly  to  an  autointoxication,  good  and  sufficient 
reason  for  the  administration  of  alum  can  be  shown  based  upon 
its  known  physiological  action.  It  is  the  2nost  powerful  in- 
testinal astringent  that  I  know  of  and  has  the  fewest  disad- 
vantages. I  have  not  noted  constipation  following  its  use  nor 
diarrhea,  nor  a  stopping  of  peristalsis,  nor  indigestion,  and  in 
any  case  its  action  lasts  at  most  only  a.  few  hours,  and  if  it  did 
all  these,  it  could  not  much  matter.  Quitman  says,  that  it  con- 
stricts the  capillaries.  If  this  is  true,  a  thing  of  which  I  am  not 
certain,  is  it  not  reasonable  to  suppose  that  as  with  other  vaso- 
constrictors, e.  g.,  digitalis,  there  is  a  selective  action  on  the  part 
of  the  capillaries  Cnot  of  the  drug)  and  those  that  need  it  most, 
i.  e.,  those  of  the  affected  feet  in  laminitis,  are  constricted  most? 
All  body  cells  exert  this  selective  action  in  the  assimilation  of 
food,  the  tissue  needing  most  any  particular  kind  of  food  cir- 
culating in  the  blood,  gets  it. 

Our  first  consideration  in  laminitis  should  be  to  remove  the 
cause — to  stop  the  absorption  of  the  toxin  in  the  intestinal  tract 
that  is  producing  the  condition.  This  we  accomplish  by  partially 
unloading  it  by  the  use  of  the  active  hypodermic  cathartics  and 
stopping  absorption  by  the  surest  and  most  harmless  of  intestinal 
astringents.  Whether  the  astonishingly  prompt  and  certain 
action  of  alum  in  this  case  is  due  wholly  to  its  astringent  action 
or  whether  alum  combines  with  the  harmful  bacterial  products 
chemically  and  forms  an  innocuous  combination,  I  can  only  sur- 
mise, and  it  is  unimportant.  At  any  rate,  when  alum  is  ad- 
ministered, the  onslaught  of  the  disease  is  promptly  stopped.  Ir- 
reparable damage  may  already  have  been  done  if  the  ease  is  a 
neglected  one,  but  whether  administered  early  or  late  in  acute 
attacks,  the  progress  of  the  disease  is  stopped  immediately. 

The  same  authority  may  be  profitably  quoted  in  the  matter 
of  handling  all  cases  wherein  the  revulsive  effect  of  agents  which 
diminish  vascular  tension  are  chiefly  indicated  or  necessarj^  as 
adjuvants.     In  this  connection,  Campbell  says : 

The  early  and  vigorous  administration  of  aconitin  in  laminitis 
to  its  full  physiological  effect,  is  more  logical.  Assuming  that 
laminitis  is  due  to  absorption  of  harmful  products  from  the 
intestinal  tract  permitted  through  the  deranged  functioning  of 
the  organs  of  digestion,  or  assuming  that  it  is  due  to  an  exten- 
sion of  the  inflammation  from  the  mucosa  to  the  sensitive  lamina, 
or  that  it  is  a  reflex  from  a  sudden  chilling  of  the  skin,  we  have 
in  anv  of  these  conditions  a  distui'bed  <'irciilalioii.  and  aconitin 


168  LAMENESS  OF  THE  HORSE 

is  the  first  and  foremost  of  circulation  "equalizers."  Further- 
more, in  laminitis  there  is  an  elevation  of  the  temperature,  an 
almost  invariable  indication  for  aconitin.  A  speedy  return  of 
the  temperature  to  normal,  a  very  marked  diminution  of  the 
pain  and  improved  conditions  generally,  appear  coincident  with 
the  symptoms  of  full  physiological  effect  of  aconitin  when  given 


Fig.  35 — Inferior  (convex)  surface  of  Cochran  shoe. 

in  cases  of  laminitis,  which  constitutes  assuredly  an  important 
part  of  its  treatment. 

Where  lameness  is  not  great  as  in  cases  wherein  no  marked 
structural  change  of  the  foot  has  occurred,  proper  shoeing  is  very 
beneficial.  By  keeping  the  heels  as  low  as  possible  and  shoeing 
without  heel  calks  a  more  comfortable  position  is  made  possible. 
Thin  rubber  pads  which  do  not  elevate  the  heel  are  of  service  in 
diminishing  concussion. 


LAMENESS   IN  THE  FORE  LEG 


169 


Dr.  David  W.  Cocb.ran  of  New  York  City  has  attained  unusual 
success  in  cases  of  chronic  laminitis  with  dropped  sole  by  the  use 
of  a  specially  designed  shoe. 

Cochran  claims  that,  not  only  are  horses  with  dropped  soles 
that  would  othei'wisio  have  to  be  put  off  the  streets  enabled  to  do 


Fig-.  36 — Superior  surface,  showing-  concavity  or  bowl,  as  formed  by  the  toe 
and  branches  of  the  shoe,  as  designed  by  Dr.  David  W.  Cochran. 

a  fair  amount  of  work  by  means  of  this  shoe,  but  that  continually 
wearing  it,  meanwhile  keeping  the  convexity  of  the  front  of  the 
hoof  rasped  thin,  in  time  brings  about  a  marked  improvement, 
and  that  after  some  months  or  years  of  use  the  animals  are  able  to 
work  with  ordinary  rubber-pad  shoes,  provided  they  are  ar- 
ranged to  facilitate  breaking  over. 

From  having  been  successfully  used  on  some  race  horses  of 


170  LAMENESS  OF  THE  HORSE 

high  value,  the  Cochran  shoe  has  attained  considerable  notoriety 
and  is  being  used  by  a  number  of  practitioners.  A  disadvantage, 
however,  arises  from  the  fact  that  few  horseshoers  other  than 
Doctor  Cochran  seem  able  to  make  the  shoe,  the  peculiar  shape 
of  which  offers  considerable  difficulty  in  forging  Concerning 
the  application  of  the  shoe  Cochran^  says : 

' '  The  most  important  primary  procedure  is  the  preparation  of 
the  foot  to  receive  the  shoe.  All  excess  of  growth  must  be 
removed  from  the  anterior  face  of  the  hoof.  The  outer  face 
must  be  reduced  at  the  toe  (not  shortened),  but  rasped  down 
thin  for  the  lighter  the  top  of  the  foot  is,  the  more  chance  the 
sole  and  coffin  bone  will  have  of  resuming  their  former  normal 
position.  The  pressure  of  the  wall  at  the  toe  upon  the  exudate 
between  wall  and  coffin  bone,  tends  to  force  the  coffin  bone  and 
sole  out  of  their  normal  position.  Leave  the  sole  alone.  You  can 
lower  the  excess  of  grow^th  at  the  heels. 

"There  are  many  designs  of  shoes  to  relieve  this  condition. 
A  great  deal  depends  on  the  judgment  of  the  shoer  to  meet  the 
conditions  presented,  depending  on  the  degree  of  the  convexity 
and  strength  of  the  sole.  In  some  cases  we  use  a  shoe  that  admits 
of  a  large  amount  of  sole  room.  Again,  we  shoe  with  a  shoe  of 
wide  cover.  In  other  cases  a  shoe  with  even  pressure  over  the 
whole  sole.  In  some  cases  a  high,  narrow  shoe,  resting  only  on 
the  wall,  or  the  ordinary  plain  shoe  with  side  calks  welded  close 
to  the  outside  edge  and  the  shoe  dished  well  from  these  as  a 
foundation.  Then  we  have  the  air  cushion  pad  designed  after 
the  model  of  the  bowl  shoe." 

In  cases  when  slight  and  persistent  lameness  interferes  suffi- 
ciently to  prevent  using  an  animal  at  any  sort  of  work  on  hard 
roads,  median  neurectomy  will  relieve  all  lameness  in  most  in- 
stances. This  is  a  safe  operation,  moreover,  in  that  no  bad  after 
effects  are  to  be  feared,  even  though  lameness  were  to  continue. 

Calk  Wounds.      (Paronychia.) 

Etiology  and  Occurrence. — Injuries  of  various  kinds  are  in- 
flicted upon  the  coronary  region  but  usually  they  are  due  to  the 
foot  being  trampled  upon.  When  the  foot  that  inflicts  the  in- 
jury happens  to  be  unshod,  a  contusion  of  the  injured  member 
is  occasioned,  Init  in  the  majority  of  instances,  wounds  that  de- 
mand attention  are  the  result  of  shoe  calks  which  have  pene- 

'The  Shoeing-  of  a  Dropped  Sole  Foot  by  Dr.  David  W.  Cochran.  New 
York    City,    The    Horse    Shoers    Journal,    March,    1915. 


LAMENESS   IN  THE   FORE  LEG  171 

trated  the  tissues  in  the  region  of  the  coronary  band.  Often 
calk  wounds  are  self-inflicted.  When  animals  are  excited  and  in 
turning  crowd  one  another,  they  often  perform  dancing  move- 
ments which  frequently  result  in  deep  calk  wounds  of  the  coro- 
net. Some  horses  have  a  habit  of  i;esting  the  heel  of  one  hind 
foot  upon  the  anterior  coronary  region  of  the  other.  While 
sleeping  in  this  position,  if  they  are  suddenly  awakened,  the 
weight  is  abruptly  shifted  to  the  uppermost  foot  and  the  one  un- 
derneath is  (because  of  the  pain  attending  its  being  wounded) 
quickly  drawn  out  from  under  its  fellow.  In  this  way  deep  cuts 
may  divide  the  coronary  band  and  inflict  extensive  injury  to  the 
sensitive  lamina  as  well. 

An  infectious  type  of  coronary  inflannnation  occurs  in  some 
localities  during  the  winter  months,  wherein  the  condition  is 
enzootic. 

Symptomatology. — Depending  upon  the  manner  in  which 
the  injury  b.as  been  produced,  the  appearance  of  the  wound 
varies  and  likewise  lameness  is  more  or  less  pronounced.  If  the 
tissues  are  not  divided  and  the  wound  is  chiefly  of  the  sul)sur- 
face  structures,  there  will  not  immediately  occur  pronounced 
local  evidence  of  the  existence  of  injury ;  but  as  soon  as  the  lame 
animal  is  nuide  to  move,  the  peculiar  character  of  the  impedi- 
ment (supporting-leg  lameness  witli  the  affected  foot  kept  well 
in  advance  of  its  normal  position)  directs  attention  to  the  ex- 
tremity and  all  of  the  symptoms  of  acute  inflanunation  are  dis- 
covered. 

Where  a  wound  is  inflicted  which  divides,  in  some  manner, 
the  surface  structures  (skin,  coronary  band,  or  the  hoof  wall) 
one's  attention  is  at  once  called  to  the  -i-xistence  of  the  wound. 

Because  of  the  fact  that  there  is  every  facility  for  the  pro- 
duction of  a  sub-coronary  and  podophylous  infection,  these 
wounds  should  receive  prompt  attention.  In  some  instances, 
the  pastern  joint  is  opened  by  calk  wounds  and  then,  of  course, 
an  infectious  arthritis  succeeds  the  injur3\ 

Treatment. — In  all  contused  wounds  of  the  coronary  region 
the  parts  need  thorough  cleansing;  the  hair,  if  long  is  clipped 
and  a  cataplasm  is  applied.  Or  preferably,  an  iodin-glycerin 
com])ination  of  one  part  of  iodin   to  four  parts  of  glycerin  is 


172  LAMENESS  OF  THE  HORSE 

poured  on  a  layer  of  cotton,  and  this  is  confined  in  contact  with 
the  inflamed  parts  by  means  of  a  bandage. 

Where  normal  resistance  to  infection  obtains,  the  subject  usu- 
ally suffers  no  suppurative  disturbance  when  the  surface  struc- 
tures are  not  broken;  and  daily  applications  of  the  antiseptic 
lotion  above  referred  to  stimulates  complete  resolution.  This 
may  be  expected  in  from  four  to  ten  days  depending  upon  the 
extent  of  the  injury. 

If  a  calk  wound  has  been  inflicted,  the  adjoining  surface  struc- 
tures are  freed  of  hair  and  the  parts  cleansed  in  the  usual  man- 
ner, (which  in  wounds  recently  inflicted,  should  be  done  without 
employing  quantities  of  water)  and  after  painting  the  wound 
surface  with  tincture  of  iodin  and  saturating  its  depths  with  the 
same  agent,  the  wound  is  cleansed,  if  it  contains  filth,  by  means 
of  a  small  curette.  By  using  a  small  and  sharp  curette,  one  is 
enaliled  to  cleanse  the  average  wound  quickly  and  almost  pain- 
lessly. 

In  such  cases,  equal  parts  of  tincture  of  iodin  and  glycerin 
are  employed.  The  wound  is  filled  with  this  preparation  and  a 
quantity  of  it  is  poured  upon  a  suitable  piece  of  aseptic  gauze 
or  cotton  and  this  is  contacted  with  the  wound.  The  extremity 
is  carefully  bandaged  and  this  dressing  is  left  in  position  for 
forty-eight  hours  unless  there  occurs,  in  the  meanwhile,  evidence 
of  profuse  suppuration — which  is  unusual. 

One  is  to  be  guided  as  to  the  progress  made  by  the  degree 
of  lameness  present.  If  little  or  no  lameness  develops,  it  is 
reasonable  to  expect  that  infection  has  been  checked;  that  the 
wound  is  dry  and  redressing  every  second  day  is  sufficiently  fre- 
quent. 

Where  cases  progress  favorably,  recovery  (unless  infectious 
arthritis  results)  should  occur  in  from  ten  days  to  three  weeks. 
Where  extensive  sub-coronary  fistulae  result,  either  from  lack 
of  prompt  or  proper  attention,  the  condition  is  then  one  requir- 
ing a  radical  operation  to  establish  drainage  and  to  disinfect 
if  possible,  the  suppurating  tissues. 

Corns. 

Etiolog'y  and  Occurrence. — In  horses,  because  of  a  tendency 
toward  contraction  of  the  heel  in  some  subjects,  together  with 


LAMENESS   IN  THE  FORE  LEG  173 

work  on  hard  roads  and  pavements,  where  the  feet  become  dry 
and  brittle,  and  because  of  neglect  of  the  matter  of  shoeing, 
this  affection  is  of  frequent  occurrence.  Unshod  horses  are  rarely 
affected.  If  conformation  is  faulty  and  too  much  weight  is 
borne  on  the  inner  or  the  outer  quarter,  and  the  hoof  wall  at 
the  quarter  tends  to  turn  inward,  corns  are  usually  present. 
They  occur  more  frequently  on  the  inner  quarters  of  the  front 
feet,  though  the  outer  quarters  are  occasionally  also  affected  and 
in  rare  instances  corns  are  found  at  the  toes.  They  do  not  often 
affect  the  hind  feet. 

As  soon  as  injury  by  pressure,  such  as  is  supposed  to  cause 
the  formation  of  corns,  is  brought  to  bear  on  the  sensitive  sole, 
an  extravasation  of  blood  occurs.  In  time  when  the  cause  re- 
mains active,  this  discoloration  is  evident  in  the  substance  of  the 
insensitive  sole  and  consists  in  a  red  or  yellowish  spot  which 
varies  in  size — this  is  ordinarily  termed  dry  corn. 

In  some  cases  where  infection  of  this  extravasation  of  blood 
and  serum  occurs,  instead  of  desiccation  and  discoloration  of  the 
insensitive  parts,  there  is,  in  time,  manifested  a  circumscribed 
area  of  destruction  of  the  insensitive  sole  and  the  abscess  may, 
where  no  provision  for  drainage  exists,  burrow  between  sensitive 
and  insensitive  laminae  and  perforate  the  tissues  at  the  coronet. 
If  the  suppurative  material  discharges  readily  by  way  of  the 
sole,  no  disturbance  of  the  heel  or  quarters  occurs  above  the 
hoof. 

Symptomatolog-y. — A  supporting-leg-lameness  characterizes 
this  condition;  and  this  lameness  in  most  instances  varies  in  de- 
gree with  the  amount  of  distress  which  is  occasioned  hj  pressure 
upon  the  inflamed  parts.  By  an  examination  of  the  sole  after 
having  removed  all  dirt,  and  exposed  the  horny  sole  to  view, 
no  difficulty  is  encountered  in  locating  the  cause  of  the  trouble. 

Treatment. — Before  suppuration  has  taken  place  and  in  tlie 
cases  where  suppuration  does  not  occur,  the  horse-shoer's  method 
of  paring  out  the  diseased  tissue  affords  a  means  of  temporary 
relief;  but  unless  frequently  done,  in  many  cases,  lameness  re- 
sults within  about  three  weeks  after  such  treatment  has  been 
given.     In  other  instances  temporary  relief  is  not  to  be  gotten 


174  LAMENESS  OP  THE  HORSE 

in  this  manner  for  any  great  length  of  time  or  until  a  more 
rational  mode  of  treatment  becomes  necessary  so  that  the  sub- 
ject may  experience  a  cessation  of  the  inconvenience  or  distress. 

The  general  plan  which  meets  with  the  approval  of  most  prac- 
titioners consists  in  careful  leveling  of  the  foot  and  removing 
enough  of  the  wall  and  sole  at  the  quarters  to  make  possible  frog 
pressure  by  means  of  a  bar  shoe.  With  frog  pressure,  expansion 
of  the  heel  follows  in  time,  and  permanent  relief  is  obtainnble 
in  this  manner.  Thinning  the  wall  of  the  quarter  is  advocated 
by  many  jn-aetitioners  and  is  undoubtedly  beneficial  in  chronic 
cases  where  marked  contraction  has  taken  place.  The  wall  must 
be  thinned  with  a  rasp  until  it  is  readily  flexible  by  compressing 
with  the  thumbs. 

There  are  instances,  however,  where  corns  and  contraction  of 
the  heel  have  existed  so  long  that  they  do  not  yield  to  treat- 
ment. Such  cases  are  found  in  old  light-harness  or  saddle-horses 
that  have  been  more  or  less  lame  for  years  and  where  there  exists 
marked  contraction  of  the  heels,  rough  hoof  walls,  and  hard  and 
atrophied  frogs. 

Suppurating  corns  require  surgical  attention  in  the  way  of 
removal  of  the  purulent  necrotic  mass  and  making  provision 
for  drainage.  Dry  dressings,  such  as  equal  parts  of  zinc  sulphate 
and  boric  acid,  may  be  employed  to  pack  the  cavity.  After  the 
infectious  condition  has  been  controlled,  and  the  wound  is  dry, 
the  same  plan  of  treatment  is  indicated  that  is  em{)loyed  in  the 
non-suppurating  corn.  Ample  time  is  allowed,  however,  for  the 
surgically  invaded  tissues  to  granulate  and,  if  the  subject  is  to 
be  put  in  service,  a  leather  pad,  under  which  there  has  been 
packed  oakum  and  tar.  affords  good  protection. 

Quittor. 

This  name  is  enqdoyed  to  designate  an  infectious  inflamnui- 
tion  of  the  lateral  cartilage  and  adjoining  structures.  The 
disease  is  characterized  by  a  slowly  progressive  necrosis  and  by 
a  destruction  of  moi'e  or  less  of  the  cartilage  and  by  the  presence 
of  fistulous  tracts. 

Etiology  and  Occurrence. — The  disease  is  due  to  the  intro- 
duction of  pus  {)roducing  organisms  into  the  subcoronary  region 


LAMENESS   IN  THE  FORE  LEG  175 

of  the  foot  under  eomlitions  whieh  favor  the  retention  of  such 
eontaii'iuni  and  extension  of  infection  into  contiguous  tissues. 

jMorbitie  material  is  introduced  into  the  region  of  the  lateral 
cartilage  by  means  of  calk  wounds  and  other  penetrant  injuries 
of  the  foot.  A  sub-coronary  abscess  which,  I)ecause  of  lack  of 
proper  care  or  because  of  virulency  of  the  contagium  or  low 
vitality  of  the  subject,  is  finite  apt  to  result  in  cartilaginous 
affection  and  its  perforation  by  necrosis  follows. 

Symptomatology. — Quittor  is  readily  diagnosed  on  sight  in 
many  instances.  AVhere  there  is  depentlable  history  or  other 
evidence  of  the  chronicity  of  an  infectious  inflammation  of  the 
kind,  quittor  is  easily  identified.  If  no  positive  evidence  of 
the  disease  exists,  by  means  of  careful  exploration  of  sinuses 
with  the  probe,  one  nuiy  distinguish  between  true  cartilaginous 
quittor  and  superficial  abscess  formation  that  is  often  accom- 
panied by  hyperplasia. 

Lameness  depends  upon  the  extent  of  the  involvement  as  it 
affects  the  structures  contiguous  to  the  cartilage.  A  variable 
degree  of  lameness  is  manifested  in  diff'M-ent  cases. 

Treatment. — Two  general  plans  of  handling  this  disease  are 
in  vogue.  One.  the  more  popular  method,  consists  in  the  in- 
jection of  caustic  solutions  of  various  kinds  into  the  fistulous 
openings  with  the  object  of  causing  sloughing  of  necrotic  tissue 
and  the  stimulation  of  healthy  granulation  of  such  wounds. 
The  other  mode  consists  in  either  complete  surgical  removal  of 
the  cartilage  or  its  remaining  j^ortions,  or  removal  of  the  dis- 
eased parts  of  curettage. 

When  quittor  has  not  extensively  damaged  the  foot  and  the 
lateral  cartilage  is  not  i)artly  ossified  as  it  is  in  some  old  chronic 
cases,  the  complete  removal  of  the  lateral  cartilage  by  means  of 
the  Bayer  operation  or  a  modification  thereof  is  indicated.  A 
complete  description  of  the  Bayer  operation  as  well  as  Merillat's 
operation  for  this  disease  (the  latter  consisting  in  part,  in  the 
removal  of  diseased  cartilage  with  the  curette)  are  given  in 
Volume  three  of  ^NFerillat's  "Veterinary  Surgical  Operations." 

Treatment  by  injection  of  caustic  solutions  has  many  advocates 
and  because  of  the  fact  that,  in  many  instances  the  condition  is 


176  LAMENESS  OF  THE  HORSE 

such  that  they  are  not  desirable  surgical  eases  and  also  because 
some  animals  may  be  put  in  service  before  treatment  is  com- 
pleted, the  injection  method  is  popular. 

The  mode  of  treatment  advocated  by  Joseph  Hughes,  M.  R. 
C.  V.  S.,  constitutes  a  very  successful  manner  of  handling  quit- 
tor  and  we  can  do  no  better  than  quote  Dr.  J.  T.  Seeley^  on  his 
manner  of  using  this  particular  treatment. 


Fig.  37 — Hyperplasia  of  riglit  fore  foot,  due  to  chronic  quittor. 

Preparation. — First  remove  the  shoe,  have  the  foot  pared 
very  thin  and  balanced  as  nicely  as  possible.  IMoreover,  all  loose 
fragments  of  horn  must  be  detached  and  all  crevices  cleaned 
thoroughly. 

Next,  have  the  leg  brushed  and  hair  clipped  from  the  knee 
or  hock  to  the  foot  and  scrubbed  with  ethereal  soap  and  warm 
water,  after  which  the  foot  must  be  scrubl^ed  in  like  manner. 
The  foot  is  then  placed  in  a  bichlorid  ])ath  several  hours  daily, 


'Quitter  and  Its  Treatment  by  the  Hughes  Method,  J.  T.  Seeley,  M.  D.  C, 
Seattle,  Washington,  Chicago  Veterinary  College  Quarterly  Bulletin,  Vol.  9, 
page  27. 


LAMENESS  IN  THE  FORE  LEG  .177 

for  from  two  to  five  days,  depending  upon  wliether  or  not  sore- 
ness is  shown.    The  bichlorid  solution  is  1  to  1,000  strength. 

On  removing  the  horse  from  the  bath  a  liberal  layer  of  gauze 
is  soaked  in  1  to  1,000  bichlorid  solution  and  placed  so  as  to  cover 
the  entire  foot.  On  discontinuing  the  bath,  cover  the  foot  with 
gauze  saturated  with  a  1  to  1,000  bichlorid  solution.  This  is  to 
be  covered  with  absorbent  cotton  and  a  gauze  bandage,  and  over 


A»  ^ 


Fig.  38 — Chronic  quittor,  left  hind  foot.     Showing  position  assumed  because 
of  painfulness  of  the  affection. 

all  is  placed  an  oil  cloth  or  silk  covering.  This  pack  is  kept  moist 
with  bichloride  solution  for  forty-eight  hours.  The  foot  is  then 
ready  for  injection. 

Preparation  of  the  Injection  Fluids. — Have  on  hand  a  pint 
of  a  one  per  cent  aqueous  solution  of  formaldehyd  made  under 
cleanly  conditions,  even  to  a  clean  bottle  and  cork,  and  a  clean 
container  when  ready  to  use  the  liquid.  Prepare  also  a  bichlorid 
of  mercury  solution  as  follows :  Ilydrarg.  Chlor.  Corros.  oIV ; 
Acid  Hydrochlor.  olss. ;  Aqua  Bulliens,   Oij.     This  should  be 


178  LAMENESS  OF  THE   HORSE 

tiiorouglily  triturated,  and  then  filtered  into  a  clean  liottle,  when 
it  is  ready  for  use. 

Injection. — The  patient  should  be  laid  on  a  table,  if  one  is 
available,  or  east,  and  the  foot  securely  fixed.  Then,  with  an 
ordinary  one-ounce  hard  rubber  syringe.  v,ith  a  good  plunger 
(tried  first  to  note  Avhether  or  not  any  fiuid  works  around  be- 
tween the  barrel  and  the  plunger),  introduce  one  syringe  full 
of  the  formaldehyd  solution,  then  thoroughly  probe  the  quittor 
to  determine  the  number  of  sinuses.  This  done,  inject  each 
sinus.  If  two  sinuses  open  on  the  surface,  close  one  -vith  cotton- 
while  filling"  the  other  so  that  if  there  is  a  connection  the  solu- 
tion will  come  in  contact  with  all  tissues  involved.  Irrigate  with 
the  full  pint  of  formaldehyd  solution  first,  then  follow  with  six 
or  eight  ounces  of  the  bichlorid  solution.  Never  probe  the  foot 
nor  allow  it  to  be  tampered  with  except  in  the  manner  pre- 
scribed. 

After-Treatment. — Put  on  a  pack  saturated  with  a  solu- 
tion of  ])ichlorid  of  mercurj'^  1  to  1,000  and  let  it  remain  two 
days.  Remove  pack,  and  once  daily  afterwards  wipe  off  with 
cotton  the  secretion  which  accumulates  on  the  outside,  and  ap- 
ply a  dry  dressing  or  healing  oil  composed  of  phenol,  camphor 
gum  and  olive  oil. 

When  Dangerous  to  Inject. — Never  inject  a  ciuittor  in  the 
acute  stage.  Never  inject  a  (|uittor  if  considerable  lameness  is 
present.  On  injecting  a  solution  of  formalin,  hold  cotton  tightly 
around  the  nozzle  of  the  syringe,  when  the  plunger  is  down, 
then  withdraw  the  syringe  gently  and  note  particularly  if  the 
fluid  returns  through  the  opening;  if  none  returns  cease  opera- 
tions at  once,  as  it  is  dangerous  to  proceed  farther,  it  indicates 
that  the  sinus  is  not  well  defined  and  the  fluid  retained  will 
cause  much  trou1)le  and  often  the  death  of  the  patient. 

Experience  has  taught  that,  if  extensive  destructive  changes 
of  the  foot  exist,  the  Bayer  operation  is  not  indicated.  In  the 
country,  where  quittors  are  not  so  frequently  met  as  in  ur'-an 
practice,  the  ]\Ierillat  operation  is  preferable  in  all  cases.  How- 
ever, the  cost  of  the  protracted  period  of  idleness,  which  con- 
valescent surgical  patients  require,  renders  the  Hughes  method 
more  satisfactory  in  the  hands  of  the  general  practitioner,  espe- 
cially in  the  city. 

Nail  Punctures. 

Nail  punctures,  as  herein  considered,  embrace  all  penetrant 
wounds  of  the  solar  surface  of  the  horse's  foot  due  to  trampling 


LAMENESS  IN  THE  FORE  LEG  179 

upou  street  nails.  This  does  not  include  accidental  nail  pricks 
occasioned  in  shoeing.  In  city  practice,  in  some  stables,  these 
cases  are  of  frequent  occurrence ;  and,  generally  speaking,  nail 
punctures  are  observed  more  frequently  in  urban  horses  than 
in  animals  that  are  kept  in  the  country. 

Occurrence  and  Method  of  Examination. — This  condition, 
then,  is  a  rather  conniion  cause  of  lameness  and  in  no  case, 
where  cause  of  the  claudication  is  not  obvious,  is  the  practitioner 


Fig.  39 — Skiagraph  of  foot.  The  X-ray  offers  very  limited  possibilities  in 
the  diagnosis  of  lameness.  The  location  of  a  "gravel"  or  a  nail  that  had 
worked  its  way  some  distance  from  the  surface,  or  of  an  abscess  of  some 
proportion,  deep  in  the  tissues,  might  be  facilitated  under  some  circumstances 
by  the  aid  of  the  X-ray.  Its  use  in  the  detention  of  fractures  is  very  limited, 
owing  to  the  difficulty  encountered  in  getting  a  view  from  the  right  position — 
many  trials  being  necessary  in  most  cases.  The  case  shown  above  was  diag- 
nosed clinically  as  incipient  ringbone.  The  X-ray  revealed  no  lesions.  (Photo 
by  L.  Griessmann.) 

warranted  in  concluding  his  examination  without  careful  search 
for  the  possible  existence  of  nail  punct'ire  of  the  solar  surface 
of  the  foot. 

In  occasional  instances  there  co-exists  an  obvious  cause  for 
supporting-leg-lameness  and  an  occult  cause — a  nail  puncture. 
Where  such  complications  ai'o  met,  the  practitioner  is  not  neces- 
sarily guilty  of  neglect  or  carch^ssnoss  when  the  nail  puncture 


180  LAMENESS  OF  THE  HORSE 

is  not  discovered  at  once,  nevertheless,  an  examination  is  not 
complete  until  practically  every  possible  cause  of  lameness  has 
been  located  or  excluded  in  any  given  case. 

In  a  search  for  nail  puncture  it  is  necessary  to  expose  to  view 
every  portion  of  the  sole  and  frog  in  such  manner  that  the 
existence  of  the  smallest  possible  wound  will  be  revealed.  This 
necessitates  removal  of  the  shoe,  if,  after  a  preliminary  ex- 
amination, a  puncture  is  not  found,  when  there  is  good  reason 
to  suspect  its  presence.  However,  where  it  is  readily  possible 
to  locate  and  care  for  a  wound  without  removal  of  the  shoe, 
allowing  the  shoe  to  remain  materially  facilitates  retaining 
dressings  in  position  and  relieves  the  solar  surface  of  contact 
with  the  ground.  If  extensive  injury  or  infection  exists,  it  is 
of  course  necessary  to  remove  the  shoe  and  leave  it  off.  By  re- 
moving a  superficial  portion  of  all  of  the  sole  and  frog,  thus 
carefully  and  completely  exposing  to  view  all  parts  of  the  solar 
surface  of  the  foot,  and  with  the  aid  of  hoof-testers  one  is  enabled 
to  positively  determine  the  existence  of  nail  punctures.  Because 
of  the  tendency  of  puncture  wounds  of  the  foot  to  close,  and 
since  the  superficial  portion  of  the  solar  structures  are  usually 
soiled,  it  is  absolutely  necessary  to  conduct  examinations  of  this 
kind  in  a  thorough  manner. 

Symtomatology. — Not  all  cases  of  nail  puncture  cause  lame- 
ness during  the  course  of  the  disturbance  and  in  many  instances 
no  lameness  is  manifested  for  some  time  after  the  injury  has 
been  inflicted — not  until  infection  has  been  the  means  of  caus- 
ing consideral)le  inflammation  of  sensitive  structures.  Never- 
theless, this  lack  of  manifestation  occurs  only  in  cases  where 
serious  injury  has  not  taken  place  and  the  degree  of  lameness 
is  a  constant  and  reliable  indicator  of  the  character  and  extent 
of  nail  punctures  within  twenty-four  hours  after  injury  has  been 
inflicted. 

The  position  assumed  by  the  affected  animal  inconstantly 
varies  with  the  location  and  nature  of  the  injury  and  is  not 
of  particular  importance  in  establishing  a  diagnosis.  The  sub- 
ject may  support  some  Aveight  with  the  affected  member  and 
stand  "base-wide"  or  "base-narrow,"  or  no  weight  may  be 
])orne  with  the  foot  or  the  animal  may  point  or  keep  the  ex- 


LAMENESS  IN  THE  FORE  LEG  181 

tremity  in  a  state  of  volar  flexion.  In  cases  where  extensive 
injury  has  been  inflicted,  and  great  pain  exists,  the  foot  is  kept 
off  the  ground  niiieh  of  the  time  and  it  may  be  swung  back  and 
forth  as  in  all  painful  affections  of  the  extremity. 

Nail  punctures  cause  typical  supporting-leg-lameness  and  in 
some  cases  certain  peculiarities  of  locomotory  impediment  are 
worthy  of  notice.  Punctures  of  the  region  of  the  heel,  which 
directly  affect  or  involve  the  deep  tendon  sheath,  cause  a  type 
of  lameness  wherein  pain  is  augmented,  when  dorsal  flexion  of 
the  extremity  occurs  as  well  as  when  weight  is  borne.  Wounds 
in  the  region  of  the  toe  of  the  hind  feet  sometimes  cause  the 
subject  to  carry  the  extremity  considerably  in  advance  of  the 
point  where  it  is  planted  and,  just  before  placing  the  foot  on  the 
ground,  it  is  carried  backward  a  little  way — ten  or  twelve  inches. 

However,  diagnosis  of  nail  puncture  is  l)ased  on  the  finding  of 
the  characteristic  wound  or  resultant  local  changes. 

Course  and  Prognosis. — The  nature  of  the  progress  and  the 
manner  of  termination  of  these  cases  are  variable.  If  the  coffin 
joint  has  been  invaded,  and  a  septic  arthritis  exists,  the  condi- 
tion is  at  once  grave.  An  open  and  infected  tendon  sheath, 
while  not  so  serious,  constitutes  a  condition  which  is  distressing, 
and  recovery  is  slow  even  under  the  most  favorable  conditions. 
Where  a  heavy,  rigid  and  sharp  nail  enters  the  foot,  in  such 
manner  that  fracture  of  the  third  phalanx  (os  pedis)  occurs, 
this  complication  makes  for  a  protraction  of  the  condition.  Ex- 
perience teaches  that  tlie  natural  course  and  termination  in 
these  cases  are  modified  by  the  location  and  depth  of  the  injury, 
virulency  of  the  contagium  and  resistance  of  the  subject  to  such 
infection. 

Prevention. — In  all  horses  w^liich  are  kept  at  such  work  that 
exposure  to  nail  punctures  is  frequent,  a  practical  means  of  pre- 
vention of  such  injuries  consists  in  ^e  employment  of  heavy 
sole  leather  or  suitable  sheet  metal  to  cover  the  sole  of  the  foot 
and,  at  the  same  time,  confine  oakum  and  tar  in  contact  with 
the  solar  surface  to  prevent  the  introduction  of  foreign  material 
between  the  foot  and  such  protecting  appliances.  Further,  if 
drivers  and  owners  could  be  impressed  with  the  serious  complica- 
tions which  so  frequently  attend  wounds  of  this  kind,  undoubt- 


182  LAMENESS  OF  THE   HORSE 

edly  many  cases  which  are  now  lost,  because  of  ignorance  or 
neglect  on  the  part  of  the  teamsters  or  proprietors  of  horses, 
would  lie  saved  by  i)ronipt  and  rational  treatment. 

Treatment. — The  treatment  of  this  condition  falls  so  largely 
within  the  dominion  of  surgery  that  we  can  give  little  more 
than  an  outline  here. 

In  cases  where  there  exists  no  evidence  of  open  joint  or  open 
tendon  sheath  as  judged  by  the  site  of  the  puncture  and  degree 
of  lameness  present  (after  having  thoroughly  cleansed  the  solar 
surface  of  the  foot  and  enlarged  the  opening  in  the  nonsensitive 
sole)  a  little  phenol  is  introduced  into  the  wound.  In  such 
cases,  where  it  is  possible  for  the  antiseptic  to  contact  every  part 
of  wound  surface  to  the  extreme  depths  of  the  puncture,  in- 
fection is  prevented  when  such  treatment  is  promptly  admin- 
istered. This  may  be  considered  as  first  aid,  or  emergency  care, 
and  is  indicated  in  all  wounds  of  the  foot  whether  the  injury 
be  serious  or  almost  insignificant. 

Subsequently  one  of  two  general  courses  may  be  pursued  in 
the  treatment  of  cases  of  nail  puncture.  One,  by  the  employ- 
ment of  means  to  keep  the  wound  patent  and  injection  of  suit- 
able antiseptics,  or  agents  that  are  more  or  less  caustic  in  con- 
junction with  strict  observance  of  asepsis  and  wound  protection. 
The  other  method  consists  in  prompt  estal)lishment  of  drainage 
by  surgical  means  and  includes  exploration  and  curettage. 

The  first  method  is  better  adapted  to  the  use  of  the  average 
general  practitioner  and  he  would  do  well  to  keep  the  opening 
in  the  nonsensitive  structures  patent.  By  introducing  equal 
parts  of  tincture  of  iodin  and  glycerin  daily,  good  results  will 
follow  in  most  instances.  The  wound  is  protected  in  unshod 
horses,  either  by  completely  bandaging  the  foot  and  retaining, 
in  contact  with  the  wound,  cotton  that  is  saturated  with  iodin 
and  glycerin,  or,  if  a  minor  injury  exists,  the  moderately  en- 
larged opening  in  the  nonsensitive  sole  or  frog,  which  has  been 
moistened  with  the  antiseptic,  is  packed  with  a  very  small  quan- 
tity of  cotton.  A  little  practice  in  this  mode  of  closing  benign 
puncture  wounds  will  enable  tlie  practitioner  to  successfully 
protect  the  sensitive  parts  in  the  treatment  of  such  cases  in  un- 
shod countrv  horses. 


LAMENESS  IN  THE  PORE  LEG  183 

When  the  condition  progresses  favorably  the  wound  may  be 
dressed  every  second  day  or  twice  weekly,  and  in  the  course  of 
from  two  to  six  weeks  recovery  should  be  complete. 

If  the  practitioner  is  somewhat  proficient  as  a  surgeon,  and 
has  at  his  command  facilities  for  doing  surgery,  the  second 
method  is  preferable  in  many  cases.  By  using  a  local  anesthetic 
on  the  plantar  nerves  and  confining  the  subject  on  an  operating 
table,  restraint  should  be  perfect.  The  solar  surface  of  the  foot 
is  first  thoroughly  cleansed,  the  puncture  wound  is  enlarged  in 
the  nonsensitive  structures  and  the  parts  are  then  moistened 
with  phenol  or  other  suitable  antiseptics.  By  means  of  a  small 
probe  the  puncture  is  explored  and,  depending  on  the  character 
of  the  wound  and  the  structures  involved,  surgical  intervention 
is  varied  to  suit  the  case.  If  necessary,  all  of  the  insensitive 
frog  is  removed,  and  in  wounds  aifecting  the  region  of  the  heel 
the  tissues  may  be  incised  from  the  puncture  outward  dividing 
all  of  the  tissues  outward  and  backward  to  the  surface.  A 
suitable  surgical  dressing  is  then  applied. 

If,  on  the  other  hand,  the  puncture  extends  into  the  navicular 
bursa,  the  radical  operation  is  perhaps  indicated,  though  not 
until  one  is  sure  that  infection  of  the  bursa  and  seiious  conse- 
quences are  to  follow  if  this  operation  is  not  performed.  De- 
tailed description  of  the  technic  of  this  operation  belongs  to  the 
realm  of  surgery  and  a  good  discussion  of  it  is  to  he  found  in 
William's  work  on  vetprinary  surgical  and  obstetrical  opera- 
tions. 

One  may  sunnnarize  the  discussion  of  treatment  of  nail  punc- 
ture by  saying  that  emergency  care  as  herein  described  is  of  first 
consideration.  In  every  ease  an  immunizing  dose  of  anti-tetanic 
serum  should  be  given.  Subsequently,  the  method  emj-loyed 
must  suit  the  character  of  the  wound,  existing  facilities  for 
handling  the  su])ject  and  the  skill  and  ajititude  of  the  prac- 
titioner. 


SECTION  IV. 
LAMENESS  IN  THE  HIND  LEG. 

Anatomo-Physiological    Consideration   of    the    Pelvic    Limbs. 

The  pelvic  bones  as  a  whole  constitute  the  analogue  of  the 
scapulae  with  respect  to  their  function  as  a  part  of  the  mechan- 
ism of  locomotive  and  supportive  apparatus  of  the  horse.  The 
manner  of  attachment  or  connection  between  the  ilia  and  the 
trunk  is  materially  different  from  that  of  the  scapulae,  how- 
ever, and  the  angles  as  formed  by  the  long  axes  of  the  ilia  in 
relation  to  the  spinal  column  are  maintained  by  two  functionally 
antagonistic  structures — the  sacrosciatic  ligaments,  and  the  a1j- 
dominal  muscles  by  means  of  the  prepubian  tendon.  The  sacro- 
iliac articulations  are  such  that  a  very  limited  amount  of  move- 
ment is  possible;  free  movement,  however,  is  unnecessary  be- 
cause of  the  enarthrodial  (ball  and  socket)  femeropelvic  joint. 

The  various  muscles  which  exert  their  effect  upon  the  pelvis 
in  changing  their  relationship  between  the  long  axes  of  the  ilia 
and  spinal  column,  are  concerned  but  little  more  in  propulsion 
and  weight  bearing  than  are  the  pectoral  muscles.  A  general 
treatise  on  the  subject  of  lameness  does  not  properly  include 
such  structures  any  more  than  it  does  the  various  affections  of 
the  dorsal,  lumbar  and  sacral  vertebrae  or  inflammation  of  the 
abdominal  parietes.  Involvement  of  such  parts  cause  manifesta- 
tions of  lameness  but  the  matter  of  establishing  a  diagnosis  is 
difficult  in  many  instances  and  in  some  cases  impossible. 

The  femeropelvic  articulation  is  formed  by  the  hemispherical 
head  of  the  femur  and  the  acetabulum ;  the  latter  constituting  a 
cotyloid  cavity  which  is  deepened  by  the  cotyloid  ligament. 

The  round  ligament  (ligamentum  teres)  is  the  principal  bind- 
ing structure  of  the  hip  joint  and  it  arises  in  a  notch  in  the 
head  of  the  femur  and  is  attached  in  the  subpubic  groove  close 
to  the  acetabular  notch.  Another  ligament,  peculiar  to  Equidae 
— the  accessory  (pubiofemoral) — is  attached  to  the  head  of  the 
femur  near  the  round  ligament  and  passes  through  the  cotyloid 

185 


186 


LAMENESS  OF  THE  HORSE 


Tendon  of 
gastrocnemius 

Superficial 
flexor  tendon 


—  Tuber  calcis 


Subcutaneous 


Tendon  of  per- 1- 

oneus  tertiuts  I 

Tibial  tarsal  bon      


Medial  ^endon  of 
tibialis  anterior 


thickening 


Tarsal  sheath 

Superficial  flexor 
tendon 
igament 


11  i_^ -iuperjiciai  jie. 

t    I  /  tendon 

j    I  /     _  Annular  ligament 


Joint  canty 
Dorsal  ligament  Vv  Vi 

Central  tarsal  bont 
Third  tarsal  bone 

Ml.  Ill 


Joint  capsule  (tarso- 
metatarsal ligament) 

Fourth  tarsal 
Perforating  tarsal  vein 
Check  ligament 
Suspensory  ligament 


Fig.  40 — Sagital  section  of  right  hock.  The  section  passes  through  the 
middle  of  the  groove  of  the  trochlea  of  the  tibial  tarsal  bone.  1  and  2.  Prox- 
imal ends  of  cavity  of  hock  joint.  3.  Thick  part  of  joint  capsule  over  which 
deep  flexor  tendon  pla.vs.  4.  Fibular  tarsal  I)one  (sustentaculum).  A  large 
vein  crosses  the  upjjer  part  of  the  joint  capsule  (in  front  of  1).  (From  Sis- 
son's  "Anatomy  of  the  Domestic  Animals.") 


LAMENESS  IN  THE  HIND  LEG 


187 


Lateral  ridge  of  trochlea  of  femur 
Lateral  femoro-tihial  ligament 

Lateral  meniscu 
Lateral  condyle  of  tib, 

Long  extensor  (stump) 

Peroneus  terti.iis 
Tibialis  anterior 
Lateral  extensor 


Extensor  hrevi. 

Teruion  of  lateral  extensor 
Tendon  of  long  extensor 


Tendinous  looj  j       \  -  #v J    fW 


Medial  ridge  of  trochlea  of  femur 


Medial  meniscus 

Medial  femoro-tibial  ligament 


Tendon  of  long  extensor 
Annular  ligament 
Peroneus  tertius 

Medial  tendon  of  tibialis  anterior 

Anterior  tendon  of  tibialis  anterior 
A  nterior  tendon  of  peroneus  tertius 

Annular  ligament 

Ml.  in 


Fig.  41- :\Ius(les  of  right  leg;  fioiit  view.  The  greater  part  of  the  long 
extensor  has  been  removed.  1,  2.  3.  Stumps  of  patellar  ligaments.  4 
Tuberosity   of  tibia.      (From   Sis.son's   "Anatomy   of   the   Domestic   AnimaLs.") 


188  LAMENESS  OP  THE  HORSE 

notch  and  along  the  under  side  of  tlje  pubis.  It  is  inserted  or 
blends  with  the  prepubic  tendon.  This  ligament  prevents  ex- 
treme abduction  of  the  leg.  The  joint  capsule  encompasses  the 
articulation  and  is  attached  to  the  brim  of  the  acetabulum  and 
the  edge  of  the  head  of  the  femur. 

The  stifle  joint  is  analagous  to  the  knee  joint  of  man  and  is 
to  be  considered  an  atypical  ginglymus  (hinge)  articulation 
formed  by  the  femur,  tibia  and  patella.  The  ligaments  are 
femerotibial,  femeropatellar  and  capsular. 

In  addition  to  the  usual  provision  for  articulation  of  bones 
there  are  situated  cartilaginous  menisci  between  the  condyles 
of  the  femur  and  the  head  of  the  tibia.  These  discs  surround 
the  tibial  spine  and  are  otherwise  shaped  to  fit  perfectly  between 
the  articular  portions  of  the  femur  and  tibia. 

Collateral  ligaments  (internal  and  external  lateral)  pass  from 
the  distal  end  of  the  femur  to  the  proximal  portion  of  the  tibia. 
The  mesial  (internal)  arises  from  the  internal  condyle  of  the 
femur  and  is  attached  to  a  rough  area  below  the  margin  of  the 
medial  (internal)  condyle  of  the  tibia.  The  lateral  (external), 
shorter  and  thicker,  arises  from  the  depression  on  the  lateral 
epicondyle  and  inserts  to  the  head  of  the  fibula. 

The  crucial  or  interosseus,  anterior  and  posterior,  are  situ- 
ated between  the  femur  and  tibia,  and  according  to  Smith,^ 
the  crucial  ligaments  are  necessary  to  properly  join  the  two 
bones,  because  of  the  character  of  the  structure  of  the  articular 
ends  of  the  femur  and  tibia. 

The  femeropatella  ligaments  are  two  thin  bands  which  re- 
inforce the  capsular  ligament.  They  arise  from  the  lateral 
aspects  of  the  femur,  just  above  the  condyles  and  are  inserted 
to  the  corresponding  surfaces  of  the  patella 

The  patellar  ligaments  are  three  strong  bands  which  arise 
from  the  antero-inferior  surface  of  the  patella,  and  are  inserted 
to  the  anterior  aspect  of  the  tuberosity  of  the  tibia. 

Taken  as  a  whole,  the  tarsal  bones,  interarticulating  and  articu- 
lating with  the  tibia  and  metatarsal  bones  form  the  hock  joint 
and  this  articulation  is  analagous  to  the  carpus.  As  with  the 
carpus,  there  is  less  movement  in  the  inferior  portion  of  the 

^Manual  of  Veterinary  Physiology.     Page  610. 


LAMENESS  IN  THE  HIND  LEG 


189 


PaUlla 


Crest  oj  tibia 

Long  digital  extensor 
Lateral  digital  extensor 


Gastrocnemius,  lateral  head 

Sok'us 

Tendori  of  gasiroaiemius 
Tarsal  icndnn  of  biceps  femcris 
Deep  f.:xor 


Superficial 
flexor  tendon 


Proximal  anmdar  ligament 
Lateral  malleolus 

Distal  annular  ligament  - 

Tendon  of  long  extensor   ■  |/  |  j 

Tendon  of  lateral  extensor  t-/ 


Branch  of  suspensory  lignm(nt  to 
extensor  tendon 


Superficial  flexor 
tendon 


Deep  flexor  tendon 


Suspensory 
ligament 


Fig.  42— Muscles  of  lower  part  of  thigh,  leg  and  foot;  lateral  view,  o'. 
Fascia  lata;  q,  q',  q",  biceps  femoris;  r,  semitendinosus;  21',  lateral  condyle 
of  tibia.  The  extensor  brevis  is  visible  in  the  angle  between  the  long  and 
lateral  extensor  tendons.  (After  Ellenberger-Baum,  Anat.  fiir  Ktinstler.) 
(From  Sisson's  "Anatomy  of  the  Domestic  Animals.") 


190 


LAMENESS  OF  THE  HORSE 


joint  than  in  the  superior  part  of  the  articulation.  The  chief 
articulating  parts  are  the  tibia  with  the  tibial  tarsal  bone  (astra- 
gulus). 

The  capsular  ligament  is  attached  around  the  margin  of  the 
articular  surfaces  of  the  tibia,  to  the  tarsal  bones,  the  collateral 


Pioximal  Liid  of 
Jimoro-ixUelldr 
ca/JbuU 


Lateral  head  of  gaslroctumius 

Lateral  feynoro-paleUar  ligament 

Attachment  of  joint  capsule 

Lateral  condyle  of  femur 

Lateral  femoro-tibial  ligament 

Poplileus 


Deep  digital  flexor 


Base  of  patella 


Distal  end  of  capsule 
Middle  patellar  ligameiU, 
Medial  patellar  ligament 

Lateral  patellar  ligament 
{slump) 

Tuberosity  of  tibia 
Tibialis  anterior 

Long  extensor 


Laterid  rxirnsor 


Fig.  43 — Right  stifle  joint;  lateral  view.  Tlie  femoro-patellar  capsule  was 
filled  with  plaster-of-Paris  and  then  removed  after  the  cast  was  set.  The 
femoro-tibial  capsule  and  most  of  the  lateral  patellar  ligament  are  removed. 
M.  Lateral  meniscus.     (From  Sisson's  "Anatomy  of  the  Domestic  Animals.") 

ligaments  (internal  and  external  lateral)  and  to  the  metatarsus. 

The  common  ligaments  of  the  tarsal  joint  are  the  collateral, 
the  plantar  (calcaneo-metatarsal  and  c.  cuboid)  and  dorsal  liga- 
ments (oblique). 

The  medial  (internal  lateral)  ligament  serves  to  join  the 
medial  (internal)  tibial  malleolus  with  tibial  tarsal  (astragulus) 
and  other  tarsal  bones. 


(LAMENESS  IN  THE  HIND  LEG 


191 


The  lateral  (external  lateral)  ligament  is  inserted  to  the  lateral 
(external)  tibial  malleolus  and  its  distal  portions  are  attached 
to  the  tibial  tarsal  (astragalus),  til)ular  tarsal  (calcaneum)  bone, 
fourth  tarsal  (cuboid)  and  metatarsus  bones. 

Base  of  pnklla 


Acccusari/  r:irlili<ie 


Medial  condyle  of 
femur 
Medial  femorn-tibial 
ligament 
Medial  meniscua 

Medial  condyle  of 
tibia 


5' '  Mcdud  ridge  of  Irovldea 

I 


Medial  patellar  ligor- 
inenl 


Middle  patellar  ligor 
merU 


T)d>erosily  of  tibia 


Fig.  44— Left  stifle  joint;  medial  view.     The  capsules  are  removed.     (From 
Sisson's  "Anatomy  of  the  Domestic  Animals.") 

The  plantar  ligament  (calcaneo-cuboid)  is  a  strong  fiat  band 
which  is  attached  to  the  plantar  surface  of  the  fibular  and  fourth 
tarsal  bones  (calcaneum  and  cuboid)  and  the  head  of  the  lateral 
mctalarsal    (external  small)   bone. 

The  dorsal  (oblique)  ligament  is  attached  al)ove  to  the  distal 
tuberosity  on  the  inner  side  of  the  tibia.  It  is  inserted  below  to 
the  central  (cuneiform  magninii)  and  third  (e.  medium)  tarsal 


lyz  LAMENESS  OF  THE  HORSE 

hones,  to  the  proximal  ends  of  the  large  and  outer  small  meta- 
tarsal bones. 

The  tarsus  is  a  true  hinge  joint  and  because  of  the  great 
stram  which  it  sustains,  is  su])ject  to  frequent  injury.  About 
seventy-fiye  percent  of  cases  of  lameness  affecting  the  hind  leg 
may  be  said  to  arise  from  disease  of  the  hock. 

As  members  of  locomotion  the  legs  receive  strains  of  two  kinds  : 
those  of  concussion  and  weight-bearing  and  strains  of  propul- 
sion ;  the  latter  are  the  greater.  In  the  horse  as  a  work  animal, 
the  hind  legs  are  probably  subjected  to  greater  strains  than  are 
the  front  but  the  manner  of  construction  of  the  various  parts 
of  the  pelvic  limbs  with  the  possible  exception  (according  to 
some  authorities)  of  the  tibial  tarsal  joint,  offsets  this  condition. 

The  femur  may  be  considered  analagous  to  the  humerus  in 
that  it  bears  a  similar  relationship  to  the  ilium,  that  exist  be- 
tween the  humerus  and  scapula.  Further  flexion  during  repose 
is  prevented  chiefly  by  the  gluteus  medius  (maximus)  muscle 
and  its  tendons.  The  larger  tendon  inserts  to  the  suuniiit  of  the 
trochanter  major  of  the  fennir  and  corresponds  to  the  biceps 
brachii  in  the  action  of  the  latter  on  the  seapulohuuieral  joint, 
except  that  the  gluteus  medius,  in  attnching  to  the  femoral 
trochanter,  exerts  its  effect  as  a  lever  of  the  first  class.  Because 
of  the  relationship  between  the  long  axes  of  the  femur  and  iliac 
shaft  it  is  evident  that  the  angle  formed  by  these  two  bones 
is  maintained  chiefly  by  the  gluteus  muscles  during  weight  bear- 
ing. Contraction  of  muscular  fibers  of  the  gluteus  medius  causes 
extension  of  the  femur  and  muscular  strain  is  prevented  to  a 
great  degree  by  the  inelastic  portion  of  this  muscle.  The  chief 
physiological  antagonistics  of  the  glutei  are  the  quadriceps 
femoris  and  tensor  fascia  lata. 

While  the  leg  is  supporting  weight  the  stifle  joint  is  fixed  in 
position  mainly  by  the  quadriceps  femoris  group  of  muscles 
which  are  attached  to  the  patella.  Tendinous  fibres  intersect 
this  muscular  mass  and  relieve  muscular  sti'ain  during  weight 
bearing.  Because  of  the  manner  in  which  the  patella  function- 
ates with  the  trochlea  of  the  femur,  comparatively  little  energy 
is  required  to  prevent  further  flexion  of  the  stifle  joints    The 


OLAMENESS  IN  THE  HIND  LEG 


193 


patella,  according  to  Strangeways,  may  be  considered  a  sesamoid 
bone. 

The  quadriceps  group  of  muscles  is  assisted  by  the  anterior 
digital  extensor    (extensor  pedis)    peroneus  tertius  and  tibialis 


Fema 


Accessory  cartilage  of  . 

patella  [ 

Medial  ridge  of  trochlea 

Medial  patellar  ligament 

Medial  epicondyle 

Medial  femoro-lihial    ■    i. 
ligament  |. 

Medial  mentbcw  -'-^ 


edial  ment^cw  —^ —  \ 
ondiile  of  tibia  — ET"    i 


Medial  condyle  of 


Tuberosity  of  'Ma 


~  Patella 


Biceps  femoris 
-  Lateral  patellar  ligament 


Lateral  femoro-libial 
ligament 

Lateral  meniscus 
Lateral  condyle  of  tibia 


Interosseous  sj)ace 

Fibula 

Interosseous  ligament 


Fig.  45— Left  Stifle  joint;  front  view.  The  capsules  are  removed.  1.  Middle 
patellar  ligament.  2.  Stump  of  fascia  lata.  3.  Stump  of  common  tendon  of 
extensor  longus  and  peroneus  tertius.  (From  Sisson's  "Anatomy  of  Domestic 
Animals.") 

anticus  (flexor  metatarsi)  muscles.  The  latter  pair  (flexor 
metatarsi,  muscular  and  tendinous  portions,  because  of  their 
attachment  to  the  external  condyle  of  the  femur  and  to  the 
metatarsal  bone)  are  enabled  to  automatically  flex  the  tarsal 
joint  when  the  stifle  is  flexed. 


194  LAMENESS   OF  THE  HORSE 

The  liock  is  kept  fixed  in  position  by  the  gastrocnemius  and 
the  superficial  digital  flexor  (perforatus).  The  latter  structure, 
which  is  chiefly  tendinous,  originates  in  tlie  supracondyloid  fossa 
of  the  femur  and  has  an  insertion  to  the  summit  of  the  fibular 
tarsal  (calcis)  bone.  It  relieves  the  gastrocnemius  of  muscular 
strain  during  weight  bearing. 

Smith^  styles  the  function  of  the  stifle  and  hock  joints  a  re- 
cijirocating  action,  and  we  quote  from  this  authority  the  follow- 
ing: 

From  Avhat  has  been  said,  it  is  evident  that  flexion  and  ex- 
tension of  stifle  and  hock  are  identical  in  their  action.  When 
the  stifle  is  extended,  the  hock  is  automatically  extended,  nor 
can  it  nnder  any  circumstances  flex  without  the  previous  flexion 
of  the  stifle.  There  is  no  parallel  to  this  in  the  body.  The  two 
joints,  though  far  apart,  act  as  one,  and  they  are  locked  by  the 
drawing  up  of  the  patella,  and  in  no  other  way.  The  so-called 
dislocation  of  the  stifle  in  the  horse  is  a  misnomer.  That  the 
patella  is  capable  of  being  dislocated  is  beyond  doubt,  but  the 
ordinary  condition  described  under  that  term,  when  the  stifle 
and  hock  are  rigid  while  the  foot  is  turned  back  with  its  wall 
on  the  ground,  is  nothing  more  than  spasm  of  the  muscles  which 
keeps  the  patella  drawn  np.  The  moment  they  relax  the  pre- 
viously immovable  limb  and  useless  foot  have  their  function 
restored  as  if  by  magic,  but  are  immediately  thrown  out  of  gear 
in  the  course  of  a  few"  minutes  as  a  recurrence  of  the  tetanus  of 
the  petallar  muscle  takes  place.  The  fascia  of  the  thigh,  like 
that  of  the  arm,  is  a  most  potent  factor  in  giving  assistance  to 
the  constant  strain  imposed  on  the  muscles  of  the  limbs  during 
standing. 

Below  the  hock  the  hind  liml)  is  arranged  like  that  of  the  fore, 
the  deei5  flexor  (perforans)  receiving  its  additional  support  from 
the  "check  ligament,"  as  in  the  fore  leg. 

The  natural  attitude  of  standing  adopted  by  the  horse  is  to 
rest  on  three  legs — one  hind  and  two  fore.  If  he  is  alert,  he 
stands  on  all  four  limbs;  but  if  standing  in  the  ordinary  man- 
ner, he  always  rests  on  one  hind  leg.  He  does  not  remain  long 
in  this  position  witliout  changing  to  the  other.  Hour  by  hour 
he  stands,  shifting  his  weight  at  intervals  from  one  to  the  other 
hind  leg,  and  resting  its  fellow  by  flexing  the  hock  and  standing 
on  the  toe.  He  never  spares  his  fore-limbs  in  this  manner  in  a 
state  of  health,  ])ut  always  stands  squarely  on  them. 

1  Manual   of   Velerinai-y   Physiology,    page   601. 


[LAMENESS  IN  THE  HIND  LEG  195 

Hip  Lameness. 

Fortunately,  ])ecause  of  the  heavy  miiseuhiture  which  goes 
to  form  a  part  of  the  loeoniotive  apparatus  of  the  rear  extremity, 
hip  lameness  is  comparatively  rare.  While  the  term  is  in  itself 
ambiguous  and  signifies  nothing  more  definite  than  does  "shoul- 
der lameness,"  yet  diagnosis  of  almost  any  condition  that  may 
be  classed  under  the  head  of  "hip  lameness"  is  not  easy  except  in 
eases  where  the  cause  is  obvious,  as  in  wounds  of  the  musculature 
and  certain  fractures.  To  the  complexity  which  the  gait  of  the 
quadruped  contributes,  because  of  its  being  four-legged,  there 
is  added  the  complicated  manner  of  articulation  of  the  bones  of 
the  hind  leg.  This  involves  the  hip  in  the  manner  of  diagnostic 
problems  and  because  of  the  inaccessibility  of  certain  parts, 
owing  to  the  bulk  of  the  musculature  of  these  parts,  diagnosis 
of  some  hip  ailments  becomes  an  intricate  problem.  Conse- 
quently, in  some  instances,  before  one  may  arrive  at  definite 
and  enlightening  conclusions,  repeated  examinations  are  neces- 
sary as  Avell  as  a  knowledge  of  reliable  history  and  recorded 
observations  of  the  subject  over  a  considerable  period. 

Rheumatic  atfections,  when  present,  usually  cause  recurrent 
attacks  of  lameness ;  myalgia,  due  to  subsurface  injury  occasioned 
l)y  contusion,  generally  produces  an  ephemeral  disturbance ;  and 
while  these  are  examples  of  cases  where  occult  causes  are  active, 
tliey  are  hy  no  means  unprecedented.  In  cases  where  the  cause 
of  lameness  is  not  definitely  located,  and  when  by  the  process 
of  exclusion  one  is  enabled  to  decide  that  the  seat  of  trouble  is 
in  the  hip,  a  tentative  diagnosis  of  hip  lameness  is  always  ap- 
propriate. 

In  one  instance  a  Shetland  pony  evinced  a  peculiar  form  of 
intermittent  lameness  which  affected  the  left  hip,  and  repeated 
examinations  did  not  disclose  the  cause  of  the  trouble.  After 
about  a  jear  there  was  established  spontaneously  an  opening 
through  the  integument  overlying  the  region  of  the  attachment 
of  the  psoas  major  (magnus"),  through  which  pus  discharged. 
With  the  occurrence  of  this  fistula,  lameness  almost  entirely 
disappeared,  but  the  emission  of  a  small  amount  of  pus  persisted 
for  more  than  a  year.     The  subject  was  not  observed  thereafter 


196  LAMENESS  OF  THE  HORSE 

and  the  outcome  in  this  case  is  not  a  matter  of  record.  Whether 
there  existed  a  psoic  phlegmon  due  to  metastatic  infection  or 
necrosis  of  a  part  of  a  lumbar  or  dorsal  vertebra  is  a  matter  for 
speculation.  Thus  the  presence  of  some  anomalous  conditions 
which  affect  the  pelvic  region  and  cause  lameness  may  be  dis- 
covered, yet  both  in  hip  and  shoulder  regions  causes  may  not  be 
definitely  located  by  means  of  practical  methods  of  examination. 

Injuries  of  all  kinds  are  the  more  frequent  causes  of  hip  lame- 
ness. In  such  cases,  lameness  may  result  directly  and  resolution 
be  prompt,  or  the  claudication  become  aggravated  in  time,  due 
to  muscular  atrophy  or  degenerative  changes  affecting  the  hip 
joint  or  nerves.  Rheumatism  or  metastatic  infection  may  be 
the  cause  of  hip  lameness  as  well  as  affections  of  the  pelvic  ])ones, 
lum])ar  and  sacral  vertebrae.  Hip  lameness  may  also  be  pro- 
voked by  melanotic  or  other  tumors. 

In  the  diagnosis  of  hip  lameness,  one  is  guided  in  a  general 
way  by  the  character  of  the  impediment  manifested.  Swinging- 
leg  lameness  is  often  present  and  the  impediment  is  more  ac- 
centuated when  the  animal  is  caused  to  step  backward.  In  many 
cases  lameness  is  ndxed,  being  about  equally  noticeable  during 
weight  bearing  and  while  the  member  is  being  swung.  By  ex- 
clusion of  causes  which  might  affect  other  parts,  one  may  defi- 
nitely locate  the  cause  of  the  trouble  or  determine  that  a  certain 
region  is  affected. 

The  sudden  manifestation  of  lameness  is  indicative  of  injury ; 
thermic  disturbances  may  signalize  metastatic  infection ;  history, 
if  dependable,  is  always  helpful.  Repeated  observations,  taking 
into  account  the  course  which  the  affection  assumes  during  a 
period  of  a  few  days,  often  serve  to  afford  a  means  of  establish- 
ing a  diagnosis  in  liaffling  cases. 

Fractures  of  the  Pelvic  Bones. 

The  OS  innominatum  may  be  so  fractured  that  the  pelvic  girdle 
is  broken,  as  in  fracture  of  the  iliac  shaft,  or  in  a  manner  that 
the  girdling  continuity  of  the  innominate  bones  is  not  inter- 
rupted. It  naturally  follows  that  greater  injury  is  done  when 
the  pelvic  girdle  is  1)roken  than  when  it  is  not,  except  in  cases 


(LAMENESS  IN  THE  HIND  LEG  197 

where  the  acetalnilmn  is  involved  and  its  hrim  not  completely 
divided. 

Etiology  and  Occurrence. — Pelvic  fractures  are  usually 
caused  by  falls  or  other  manner  of  contusion.  Cases  are  re- 
ported where  it  would  seem  that  fracture  of  the  iliac  angle  re- 
sulted from  muscular  contraction,  but  it  is  certain  that  most 
fractures  of  this  kind  are  due  to  collisions  with  door  jambs  or 
similar  injuries.  In  old  horses  especially,  fracture  of  pelvic 
bones  occurs  frequently.  This  form  of  injury  is  of  more  frequent 
occurrence  in  animals  of  all  ages  that  work  on  paved  streets. 
The  country  horse  is  not  subjected  to  the  uncertain  footing  of 
the  slippery  pavement,  nor  to  injuries  which  compare  with  those 
caused  by  contusions  sustained  in  falling  npon  asphalt  or  cobble- 
stones. 

Symjptomatology. — While  in  many  cases  of  pelvic  fracture 
lameness  or  al)nornial  decumbency  are  the  salient  manifestations, 
yet  the  pathognomic  symptoms  are  crepitation  or  palpable  evi- 
dence which  may  be  ol)tained  by  rectal  or  vaginal  examination. 
In  fractures  of  the  angle  of  the  ilium  and  the  ischial  tulierosity, 
perceptible  evidence  always  exists. 

In  cases  where  fracture  of  some  portion  of  the  pelvic  girdle 
is  suspected  and  the  subject  is  able  to  walk,  crepitation  is  sought 
by  placing  one  hand  on  an  external  angle  of  the  ilium  and  the 
other  on  the  ischial  tul)erosity  and  the  animal  is  then  made  to 
walk.  Or,  by  placing  the  hands  as  just  directed,  an  assistant 
may  grasp  the  horse's  tail  and  by  alternately  exerting  traction 
on  the  tail  and  pushing  against  the  hip  in  such  manner  that 
weight  is  shifted  from  one  leg  to  the  other,  crepitation  may  be 
detected. 

Fracture  of  the  pubis  near  its  symphysis  constitutes  a  grave 
injury,  as  there  is  danger  of  the  bladder  becoming  caught  in  the 
fissure  and  perforation  of  its  wall  may  result.  Such  a  case  is 
reported  by  Bauman'^  wherein  a  three-year-old  gelding  bore  the 
history  of  having  l)een  lame  for  ten  days.  Upon  rectal  examina- 
tion the  bladder  was  found  to  be  hard  and  tumor-like  and  about 
the  size  of  a  baseball.     The  body  of  the  ischium  in  this  case 


^Case  report  at  meeting  of  the  Iowa  State  Veterinary  Medical  Associatioii, 
Jan.,    1904,   by  Dr.    S.   H.  Bauman,  Birmingham,   la. 


198  LAMENESS  OF  THE  HORSE 

was  fractured  and  a  rent  in  the  bladder  was  caused  by  a  sharp 
projecting  piece  of  bone.  Autopsy  revealed,  in  addition  to  the 
fracture  and  rent  of  the  l)ladder  wall,  a  large  quantity  of  urine 
in  the  peritoneal  cavity. 

In  other  instances  hemorrhage  caused  death  and  not  infre- 
quently infection  was  responsible  for  a  fatal  issue.  Moller,- 
quoting  Nocard,  describes  a  case  where  fracture  occurred  through 
the  region  of  the  foramen  ovale  and  paralysis  of  the  obturator 
nerve  followed. 

Fractures  which  include  the  acetabular  bones  cause  great  pain. 
This  is  manifested  by  marked  lameness,  both  during  weight 
bearing  and  when  the  member  is  swung.  Such  cases  terminate 
unfavorably — complete  recover}^  is  impossible. 

Where  small  portions  of  the  angle  of  the  ilium  are  broken,  and 
the  skin  is  left  intact,  there  exists  the  least  troublesome  class 
of  pelvic  fracture.  If  large  portions  of  the  ilium  are  fractured, 
considerable  disturbance  results.  There  eventually  occurs  more 
or  less  displacement  in  such  cases,  if  such  displacement  does  not 
take  place  at  the  time  of  injury.  The  same  may  be  said  of  frac- 
ture of  the  tuber  ischii,  but  when  these  bones  are  fractured  a 
more  serious  condition  results. 

Treatment. — AVhen  a  case  is  found  to  be  uncomplicated,  that 
is,  if  the  fracture  is  such  that  recovery  seems  possible  and  after 
having  determined  that  treatment  may  be  practicable,  the  first 
consideration  is  that  of  confining  the  subject  in  suitable  slings. 
In  many  cases  of  pelvic  fracture,  the  atfected  animal  will  need 
to  be  kept  in  slings  from  six  weeks  to  three  months,  and  it  l)e- 
comes  a  difficult  problem  to  minimize  the  distress  during  this 
long  period  of  confinement  in  the  peculiar  manner  required  for 
favorable  outcome. 

The  pattern  of  sling  employed  should  be  the  best  that  is  ob- 
tainable aud  the  matter  of  its  adjustment  is  quite  important  lest 
unnecessary  chafing  or  even  necrosis  of  skin  result.  Frequent 
readjustment  may  be  necessary,  and  time  is  well  spent  in  this 
manner  since  this  contributes  materially  toward  a  favorable 
termination  by  encouraging  the  subject  to  remain  q\iiet  so  that 


^Regional   Veterinary    Surgery    and    Operative    Technique,    by    .Tohn    A.    W. 
Dollar,  M.  R.  C.  V.  S.,  F.  R.  S.  E.,  M.  R.  I.,  page  733. 


LAMENESS  IN  THE  HIND  LEG  199 

coaptation  of  the  broken  bones  may  be  maintained.  Aside  from 
slings,  mechanical  appliances  that  are  helpful  in  the  treatment 
of  these  cases  are  not  yet  in  use. 

A  regimen  that  is  nutritive  and  at  the  same  time  laxative  is 
essential  and  in  some  cases  cathartics  and  enemata  are  necessary. 
Also,  during  the  t:rst  few  days,  if  there  is  retention  of  urine, 
catheterization  is  imperative.  In  a  word,  the  handling  of  such 
cases  consists  largely  in  keeping  the  subject  inactive,  as  com- 
fortable as  possible,  and  giving  attention  to  suitable  diet. 

Simple  fracture  of  the  external  iliac  angle  needs  no  particular 
attention,  except  that  the  subject  is  kept  quiet  until  lameness 
subsides.  In  all  cases  where  much  of  the  bone  is  broken,  the  ani- 
mal is  blemished,  but  interference  with  function  does  not  follow. 
If  infection  results  because  of  a  compound  fracture,  loose  pieces 
of  bone  must  be  removed  surgically  and  drainage  provided  for. 

In  fracture  of  the  ischial  tuberosity,  infection  is  more  apt  to 
result  than  in  like  injury  of  the  ilium,  and  greater  displacement 
of  bone  occurs.  This  displacement,  due  to  contraction  of  the 
attached  muscles,  is  in  some  instances  a  contributing  cause  to 
the  infection  which  often  follows  in  these  cases.  In  females 
where  the  body  of  the  ischium  is  fractured,  lacerations  of  the 
vagina  may  be  present,  and  this  constitutes  a  serious  complica- 
tion which  usually  terminates  fatally. 

After-care  in  fracture  of  the  pelvic  girdle  consists  principally 
in  allowing  a  protracted  period  of  rest  before  subjects  are  i)ut 
to  work. 

Fractures  of  the  Femur. 

Etiology  and  Occurrence, — This  is  a  comparatively  rare  in- 
jury in  the  horse  because  of  the  protection  afforded  the  femur 
by  the  heavy  musculature.  Fragilitas  of  the  bone  probably 
exists  in  many  cases  when  fracture  of  its  diaphysis  occurs.  It 
is  generally  conceded  that  the  neck  of  the  femur  is  rarely  broken 
because  of  a  lack  of  constriction  in  this  part,  but  fracture  of  the 
trochanters  has  been  recorded  rather  frequently.  However, 
Lienaux  and  Zwanenpoete^  state  that  fracture  of  the  neck  of 
the  femur  is  of  frequent  occurrence  in  Belgian  colts.     Tapley- 


lAs  quoted   bv   A.    Liautard,    M.    15.,    V.   M.,   American   Veterinary   Review, 
Vol.  37,  page  667. 

^Quoted  by  Prof.  Liautard,  American  Veterinary  Review,  Vol.   33,  page  190. 


200  LAMENESS  OP  THE  HORSE 

reports  in  the  Veterinary  Jonrnal  (English)  fracture  of  the  head 
and  internal  trochanter  of  the  femur  and  patellar  luxation  oc- 
curring simultaneously  affecting  a  mule.  In  this  case  the  mule 
was  found  decumbent  on  a  concrete  floor.  After  three  weeks, 
the  subject  was  destroyed  and  autopsy  revealed  rupture  of  the 
left  pubiofemoral  ligament,  tearing  with  it  a  portion  of  the 
articular  surface  of  the  femur.  The  internal  trochanter  was 
also  fractured  in  four  small  pieces.  In  this  case  it  is  fair  to 
suppose  that  the  mule  in  trying  to  regain  footing  on  a  slippery 
floor  violently  abducted  the  legs  and  fracture  resulted.     It  is 


Fig.  46 — Oblique  fracture  of  the  femur  of  a  1,500  six-year-old  draft  hoi'se. 
Showing-  shortening  of  bone,  owing  to  a  lateral  approximation  of  the  diaphysis 
because  of  muscular  contraction.     Photo  by  Dr.  Edward  Merillat. 

possible  also  that  a  temporary  luxation  of  the  patella  took  place 
first  and  caused  the  animal  to  struggle  in  such  manner  that  frac- 
ture followed. 

Symptomatology. — According  to  Cadiot  and  Almy,'  "regard- 
less of  the  location  of  femoral  fractures,  the  subject  is  usually 
intensely  lame,  the  animal  frequently  w;dking  on  three  legs — 
fractures  of  the  diaphysis  are  characterized  by  an  alinormal  mo- 
l)ility." 

As  a  rule,  crepitation  is  to  be  recognized  in  fractures  of  the 


iTraite   de   Thgrapeutique    Chirurgical   des   Animaux   Domestique   par   V.    J. 
Cadiot  et  J.  Almy,  Tome  second,   page  460. 


LAMENESS  IN  THE  HIND  LEG  201 

shaft  of  the  bone,  by  passively  moving  the  leg  to  and  from  the 
medial  plane  (adduction  and  abduction). 

Fracture  of  the  trochanter  major  is  signalized  by  local  swelling 
and  evidence  of  pain;  the  forward  stride  is  shortened  because 
this  movement  tenses  the  tendon  of  the  gluteus  major  (maximus) 
which  is  attaclicd  principally  to  the  trochanter. 

Treatment.— Reduction  of  femoral  fracture  in  the  horse  is 
practically  impossible,  and  retaining  the  broken  bones  in  coapta- 
tion is  not  possible  by  means  of  mechanical  appliances.  Conse- 
ciuently,  prognosis  is  unfavorable  in  fracture  of  the  body  of  the 
femur.     When  union  of  bone  occurs,  there  results  shortening  of 


Pig  47 — Same  bone  as  in  Fig.  46  after  about  six  months'  treatment.  In  this 
case  Dr.  Merillat  employed  a  weight  to  counteract  muscular  contraction.  It 
is  noticeable  that  very  little  provisional  callus  has  formed  in  this  case,  and 
in  spite  of  unusual  ingenuity  and  good  facilities  for  caring  for  the  subject, 
union  of  bone  did  not  occur. 

the  leg  and  animals  are  rendered  permanently  lame.  If  the 
immediate  region  of  the  head  of  the  bone  is  involved  as  well  as 
in  case  of  fracture  of  the  condyles,  an  incurable  arthritis  ensues. 
Where  the  trochanters  are  broken,  chronic  lameness  and 
muscular  atrophy  is  the  result.  Therefore,  it  is  evident  that, 
because  of  the  manner  of  function  of  the  femur,  the  leverage 
afforded  by  its  great  trochanter  and  its  heavy  muscular  attach- 
ments, fractures  of  this  bone  in  the  horse  do  not  terminate  favor- 
ably. 

Luxation  of  the  Femur. 

Etiology  and  Occurrence. — Uncomplicated  femoral  luxation 
is  of  less  frequent  occurrence  in  the  jiorse  than  in  the  other 


202  LAMENESS  OF  THE  HORSE 

domestic  animals.  The  deep  cotyloid  cavity  renders  disarticula- 
tion ditBcult  and  luxation  does  not  often  take  place.  Complica- 
tions that  usually  occur  are  rupture  of  the  round  (coxofemoral) 
ligament  or  fracture  of  the  neck  of  the  femur.  Falls  or  violent 
strains  are  necessary  to  produce  this  luxation.  Goubaux  is 
quoted  by  Cadiot  and  Almy^  as  having  observed  the  head  of  the 
femur  in  an  instance  wherein  luxation  had  long  existed.  In  this 
case  autopsy  revealed  the  fact  that  the  inner  portion  (two-thirds) 
of  the  head  of  the  femur  had  completely  disappeared. 

Luxation  of  the  femur  is  observed  in  old  emaciated  animals 
that  are  worked  on  slippery  pavements.  Occasionally,  evidence 
of  chronic  luxation  of  the  femur  is  observed  in  the  anatomical 
laboratory.  The  chronicity  of  the  condition  is  o])vious  when 
one  notes  the  well  formed  articulation  which  Nature  provides 
for  the  head  of  the  femur,  where  fractuie  or  other  serious  com- 
plications are  not  present. 

Symptomatology. — In  every  case  there  must  exist  either 
restriction  of  movement  or  an  evident  abnormal  position  of  the 
leg,  or  both  conditions  may  exist  at  once.  Also,  the  leg  may  be 
markedly  shortened.  IManifestation  of  this  affection  varies,  de- 
pending upon  the  character  of  the  luxation  (position  of  the 
head  of  the  humerus  with  relation  to  the  acetabulum).  Lusk^ 
cites  a  case  of  a  mule  which  had  suffered  femoral  luxation.  The 
animal  was  destroyed  and  on  autopsy  the  head  of  the  fenuir 
found  to  be  contained  within  a  false  articular  cavity  situated 
about  four  inches  above  the  acetabulum.  In  Dr.  Lusk's  case  as 
he  states  it,  the  following  symptoms  were  presented:  "Limb 
shortened  and  fixed  in  a  position  of  adduction.  While  standing 
the  affected  limb  hung  directly  across  and  in  front  of  the  oppo- 
site one ;  upper  trochanter  very  prominent ;  skin  over  hip  joint 
very  tense.  The  mobility  of  the  limb  was  very  limited,  especially 
in  the  forward  direction." 

Being  very  prominent  when  there  is  an  upward  luxation  and 
less  perceptible  in  downward  displacement,  the  location  of  the 
trochanter  major  is  an  indicator  of  the  character  of  the  luxation 
with  respect  to  the  positicm  of  the  head  of  the  femur.     This 


iTraite  de  Therapeutique  Chiruig-ical,   Tome  .second,  pase   ido. 
=Luxation    of    the    Femur,    by    AVm.    V.    Lusk,    Veterinary    Surgeon,    U.    S. 
Cavalry,  American  Veterinary  Review,  Vol.  21,  page  254. 


LAMENESS  IN  THE  HIND  LEG  203 

variation  of  position  causes  abnormal  tenseness  or  looseness  of 
the  skin  over  the  region  of  the  trochanter  major.  Rectal  ex- 
amination IP  of  aid  in  locating  the  head  of  the  humerus. 

Treatment. — AVhen  it  is  evident  that  a  suhjeet  should  1)e 
given  treatment  and  not  destroj^d,  the  animal  must  be  cast  and 
completely  anesthetized.  With  complete  relaxation  thus  secured 
by  rotation  of  the  limb,  using  the  hip  joint  region  as  a  pivot,  re- 
duction may  be  effected.  Traction  is  exerted  in  the  same  direction 
from  the  acetabulum  that  the  head  of  the  femur  is  situated  and 
by  pressing  over  the  joint,  the  displaced  bone  may  be  returned 
in  position.  If  luxation  is  downward,  traction  on  the  extremity 
will  tend  to  dislodge  the  head  of  the  femur  from  the  inferior 
acetabular  margin  making  reduction  possilile. 

The  same  general  plan  Avhieh  is  ordinarily  employed  in  cor- 
recting luxation  is  indicated  here,  but  because  of  the  heavy 
musculature  of  the  hip,  complete  anesthesia  is  imperative  in  all 
such  manipulations. 

Gluteal  Tendo-S5movitis. 

The  gluteus  medius  (g.  maxinuis)  muscle  is  inserted  chiefly  by 
means  of  two  tendons ;  one  to  the  summit  of  the  trochanter  major 
of  the  femur  and  the  other  passing  over  the  anterior  part  of  the 
convexity  of  the  trochanter,  and  being  attached  to  the  crest  be- 
low it.  The  trochanter  is  covered  with  cartilage,  and  a  bursa 
(the  trochanteric)  is  interposed  between  the  tendon  and  the 
cartilage. 

Etiology  and  Occurrence. — This  affection  is  probably  caused 
in  most  instances  1)y  direct  injury  to  the  parts,  such  as  may  be 
occasioned  by  being  kicked,  falling  on  pavement,  or  being  struck 
by  the  body  of  a  heavy  wagon.  Strains  in  pulling  or  in  slipping 
are  undoubtedly  causative  factors  and  in  draft  horses  such 
strains  may  result  in  involvement  of  this  synovial  apparatus. 

Symptomatology. — Tf  pain  l)e  severe  and  inflammation 
acute,  weight  may  not  be  borne  with  the  affected  member.  There 
is  some  local  manifestation  of  the  condition  in  acute  cases. 
Swelling  of  the  tissues  contiguous  to  the  bursa  is  present  and 


204  LAMENESS  OP  THE  HORSE 

pain  is  evinced  upon  manipulation  of  the  parts.  A  character- 
istic gait  marks  inflammation  of  the  trochanteric  bursa,  and  as 
G-unther  has  put  it,  the  subject  generally  moves  or  trots  as  does 
the  dog — the  sound  member  being  carried  in  advance  of  the 
affected  one  and  the  forward  stride  of  the  diseased  leg  is  short- 
ened. In  some  chronic  cases  crepitation  is  discernible  by  holding 
the  hand  on  the  trochanter  while  the  subject  walks. 

Treatment.— In  the  first  stages  of  an  acute  affection  abso- 
lute quiet  must  be  enforced;  local  antiphlogistic  applications 
are  bencfioial.  Later,  vesication  of  a  liberal  area  surrounding 
the  trochanter  major  is  indicated.  Where  the  condition  has  be- 
come chronic  in  horses  that  are  to  be  kept  at  heavy  draft  work 
there  is  little  chance  for  complete  recovery.  And,  naturally, 
one  is  not  to  expect  resolution  in  cases  where  there  exist  erosion 
and  ossification  of  cartilage — where  crepitation  is  discernible. 

Paralysis  of  the  Hind  Leg. 

Aside  from  paraplegic  conditions  due  to  disease  of  the  cord  or 
the  lumbosacral  plexus,  and  monoplegic  affections  resultant  from 
disturbances  of  this  plexus,  paralysis  of  certain  nerves  are  oc- 
casionally encountered. 

Anatomy. — The  lumbosacral  plexus  results  substantially 
from  the  union  of  the  ventral  branches  of  the  last  three  lumbar 
and  the  first  two  sacral  nerves,  but  it  derives  a  small  root  from 
the  third  lumbar  nerve  also.  The  anterior  part  of  the  plexus 
lies  in  front  of  the  internal  iliac  artery,  between  the  lumbar 
transverse  processes  and  the  psoas  minor.  It  supplies  branches 
to  the  iliopsoas^  (designated  by  Girard,  the  iliacomuscular 
nerves) .  The  posterior  part  lies  partly  upon  and  partly  in  the 
texture  of  the  sacrosciatic  ligament.  From  the  plexus  are  de- 
rived the  nerves  of  the  pelvic  limb   (Sisson). 

Paralysis  of  the  Femoral  (Crviral)  Nerve. 

Anatomy.— Til e  femoral  nerve  (crural)  is  derived  chiefly 
from   the   fourth   and   fifth   lumbar  nerves.     It  runs  ventrally 

'Because  of  the  intimacy  of  the  psoas  major  (p.  magnus)  and  the  iliacus 
they  are  sometimes  called  iliopsoas. 


[LAMENESS  IN  THE  HIND  LEG  205 

and  backward,  at  first  between  the  psoas  major  and  minor,  then 
crosses  the  deep  face  of  the  tendon  of  the  latter  and  descends 
under  cover  of  the  sartorious  over  the  terminal  part  of  the 
ilioisoas.  It  innervates  the  psoas  major  (magnus),  psoas  minor 
^parvus),  sartorious,  rectus  femoris,  vastus  lateralis  (internus). 
Branches  supply  the  stifle  and  the  adductor  and  pectineus  mus- 
cles. 

Etiology  and  Occurrence. — While  paralysis  of  the  femoral 
nerve,  also  known  as  "dropped  stifle"  occurs  as  a  result  of  local 
injuries  and  melanotic  tumors  in  gray  horses,  most  cases  are  due 
to  azoturia.  So-called  crural  paralysis  or  "hip  swinney"  is  oc- 
casionally observed  but  this  is  not  a  condition  wherein  the  nerve 
is  affected  in  the  manner  that  characterizes  the  marked  atrophy 
of  quadriceps  femoris  (crural)  muscles  in  some  cases  of  hema- 
globinuria.  This  form  of  paralysis  according  to  Hutyra  and 
]Marek  is  due  primarily  to  diffuse  degeneration  of  the  muscles. 

Symptomatology. — AVhen  muscular  atrophy  is  not  extensive 
no  particular  evidence  of  this  condition  may  be  manifested  while 
the  subject  is  at  rest,  but  where  muscular  waste  has  occurred, 
the  nature  of  the  ailment  is  at  once  recognized.  Since  the  fem- 
oral nerve  supplies  the  quadriceps  femoris  muscles,  it  follows 
that  when  the  psoic  portion  of  this  nerve  becomes  diseased,  the 
stifle  loses  its  support,  and  in  a  unilateral  involvement  when  the 
subject  attempts  to  walk  on  the  affected  member,  the  stifle  sinks 
down  for  want  of  support  and  the  leg  collapses  unless  weight  is 
caught  up  with  the  other  leg.  Often,  following  azoturia,  a 
bilateral  affection  is  to  be  observed. 

Treatment, — Horses  may  be  restrained  in  the  standing  posi- 
tion, and  in  the  average  instance,  a  twitch  and  hood  are  all  the 
restraining  appliances  necessary. 

In  cases  where  the  disease  is  unilateral  and  atrophy  is  not  of 
too  long  standing,  recovery  is  possible  in  vigorous  subjects.  All 
affections,  however,  wherein  degenerative  changes  involve  the 
nerve  trunk,  whether  due  to  diffuse  myositis  or  pressure  from 
malignant  tumors,  will  not  yield  to  treatment. 

The  same  general  plan  of  treatment  is  indicated  that  is  de- 
scribed  on   page   7-4   in   the   consideration   of   atrophy   of   the 


206  LAMENESS  OF  THE  HORSE 

.scapular  muscles.  It  is  especially  important  to  provide  for  the 
subject  to  be  exercised  when  there  is  atrophy  of  the  quadriceps 
muscles  following  azoturia. 

In  addition  to  the  foregoing,  good  results  have  attended  the 
use  of  intramuscular  injections  of  oxygon.  The  technie  of  the 
operation  consists  in  preparing  the  area  of  skin  which  covers 
the  atrophied  muscles  as  for  any  operation.  The  hair  is  clipped 
over  five  or  six  or  more  circular  areas  of  about  an  inch  in  diame- 
ter; the  skin  is  cleansed  and  then  painted  with  tincture  of  iodin. 

A  long  heavy  sterile  needle,  which  is  connected  with  an  oxygen 
tank  by  means  of  six  feet  of  rubber  tubing,  is  thrust  into  the 
depths  of  the  affected  muscles  and  the  gas  is  gently  introduced 
into  the  tissues.  One  needs  exercise  extreme  care  that  the  gas 
enter  slowly  because  great  pain  is  produced  by  the  sudden  in- 
jection of  the  oxygen.  Likewise  too  nmch  of  the  gas  must  not 
be  introduced  at  one  place.  When  the  oxygen  is  slowly  intro- 
duced it  may  be  allowed  to  enter  the  tissues  until  the  subject 
gives  evidence  of  experiencing  considerable  pain,  or  if  the  parts 
are  not  particularly  sensitive,  a  reasonable  amount  (enough  to 
cause  a  mild  degree  of  diffuse  inflammation)  is  introduced  at 
each  one  of  five  or  six  points.  In  large  animals  more  points 
of  injection  may  be  used. 

No  infection  or  other  bad  results  will  follow  the  execution  of 
a  good  technie  and  the  treatment  may  be  repeated  every  three 
or  four  weeks  until  either  marked  regeneration  of  tissue  is  evi- 
dent or  the  case  is  obviously  proved  hopeless. 

Paralysis  of  the  Obturator  Nerve. 

Anatomy. — The  obturator  nerve,  situated  at  first  under  tlie 
peritoneum,  accompanies  the  ol)turator  artery  through  the  ob- 
turator foramen  and  gaining  tlie  muscles  on  the  internal  face 
of  the  thigh,  terminates  in  the  obturator  externus,  adductors, 
peetineus  and  gracilis,  also  giving  twigs  to  the  obturator  in- 
ternus   (Strange ways). 

Etiology  and  Occurrence. — This  condition  occurs  upon  rare 
occasions  as  tlie  result  of  injury  such  as  falls  which  cause  ex- 
treme abduction  of  the  legs,  or  in  pelvic  fracture  where  the 


ILAMENESS  IN  THE  HIND  LEG  207 

nerve  is  directly  injured,  or  when  melanotic  tumors  or  other 
new  growths  compress  the  nerve  in  such  manner  that  its  function 
is  suspended.  Paralysis  of  the  obturator  nerve  or  nerves  is  met 
with  rather  frequently,  notwithstanding',  in  mares,  following 
dystocia.  The  nerves  (one  or  both)  may  become  bruised  at  the 
lu'im  of  the  oliturator  foramen  by  being  caught  between  the  pel- 
vis and  the  body  of  the  fetus  in  some  cases  of  protracted  labor. 

Symptomatology. — Tn  a  unilateral  affection  there  may  be 
little  evidence  of  the  trouble  while  the  subject  is  standing;  or 
there  is  to  be  seen  some  abduction;  or  the  affected  member  may 
present  abduction  of  the  stifle  and  stand  "toe  outward."  If 
the  animal  is  walked  there  will  be  manifested  more  or  less  abduc- 
tion and  the  character  of  the  impediment  varies  according  to 
the  nature  of  the  involvement. 

Following  protracted  cases  of  labor  in  some  instances  where 
only  a  unilateral  paralysis  exists,  walking  is  performed  with 
difficulty;  the  subject  may  be  unal^le  to  support  weight  witli  the 
affected  member  and  is  obliged  to  hop  on  the  one  sound  hind  leg. 
In  bilateral  affections,  they  are  iinable  to  rise.  If  the  condition 
is  severe  the  sling  is  required  to  keep  the  subject  standing,  and 
with  this  care,  recovery  Avill  follow. 

Treatment. — If  new  growths  or  callosities  or  similar  condi- 
tions affect  the  nerve,  little,  if  any,  hope  for  recovery  exists.  In 
young  and  vigorous  subjects  where  cause  is  not  definitely  known, 
a  course  of  strychnin  may  be  given.  Good  nursing,  providing 
for  the  subject's  comfort  and  allowing  moderate  exercise,  consti- 
tute rational  treatment.  Stimulating  embrocations  on  the  ab- 
ductor muscles  resorted  to  in  cases  during  the  incipient  stage 
may  prove  helpful. 

"When  paralysis  of  the  obturator  nerve  occurs  as  a  post-partum 
complication,  and  other  conditions  are  favorable,  the  subject 
should  be  raised  to  its  feet  without  unnecessary  delay.  If  the 
mare  is  unable  to  assist  in  regaining  her  feet,  a  sling  is  recpiired. 
Usually  little  else  is  necessary  and  after  a  few  days  in  the  sling 
the  subject  can  get  about  unassisted.  In  the  meanwhile  the 
well-being  of  the  affected  animal  is  to  be  considered  just  as  in 
any  other  case  where  the  patient  is  so  confined.     The  foal  in 


208  LAMENESS  OF  THE  HORSE 

siieh  instances  constitutes  a  source  of  some  trouble,  but  the  aver- 
age mare  offers  no  serious  resistance  to  the  confinement  occa- 
sioned by  the  sling. 

Good  hygienic  care,  a  suitalile  diet  and  full  i^hysiological  doses 
of  strychnin  are  indicated.  Cadiot  and  Almy  recommend  vaginal 
douches  of  cold  water  and  counterirritation  of  the  region  of  the 
inner  thigh  in  these  cases. 

Paralysis  of  the  Sciatic  Nerve. 

Anatomy. — The  great  sciatic  nerve  leaves  the  pelvis  in  com- 
pany with  the  gluteal  nerves,  through  the  great  sciatic  foramen 
(notch),  passing  downward  along  the  posterior  face  of  the  femur. 
Near  the  stifle  it  passes  between  the  two  heads  of  the  gastroc- 
nemius muscle  and  continues  as  the  tibial.  Branches  supply 
the  following  muscles — ol)turat<)r,  semimem])ranosus  (adductor 
magnus),  biceps  femoris  (triceps  abductor  femoris),  semitendi- 
nosus  (biceps  rotator  tibialis),  lateral  extensor  (peroneus)  and 
the  tibial  nerve,  its  continuation,  innervates  the  digital  flexors. 

Etiology  and  Occurrence. — Paralysis  of  the  great  sciatic 
nerve  may  be  caused  by  central  disorders,  injury  in  falling,  frac- 
tures and  new  growths.  Because  of  its  protected  position,  this 
nerve  does  not  often  suffer  injury,  and  paralysis  of  the  sciatic 
nerve  is  recorded  in  a  few  instances  owing  to  its  rarity. 

Symptomatology. — When  consideration  is  given  the  number 
of  muscles  that  are  supplied  by  the  sciatic  nerve  and  the  func- 
tion of  these  muscular  structures,  it  is  obvious  that  the  leg 
cannot  be  used  in  sciatic  paralysis.  However,  the  limb  is 
capable  of  sustaining  weight  when  it  is  fixed  in  position,  but  this 
is  done  without  exertion  of  muscular  fibers  which  are  supplied 
by  the  great  sciatic  nerve.  Trotting  is  impossilile  and  flexion 
of  the  affected  member  is  also  likewise  precluded.  The  foot  is 
dragged  when  the  subject  is  caused  to  advance. 

Under  the  heading  "sciatica,"  Scott^  has  described  a  case  of 
acute  sciatic  affection  wherein  a  pacing  horse  manifested  evidence 
of  great  pain  of  a  nervous  character.     There  were  muscular 


iDr.  John  .Scott,   Peoria,    III.,   in   The  American  Veterinary  Review,   Vol.   16, 
page  16. 


LAMENESS  IN  THE  HIND  LEG  209 

twitchings  and  the  leg  was  held  off  the  floor  and  moved  about 
convulsively.  Breathing  was  very  much  accelerated,  pulse  85 
per  minute,  the  temperature  was  103°  and  manipuhition  of  the 
hips  augmented  the  pain. 

This  was  not  a  paralytic  condition  and  recovery  resulted,  yet 
undoubtedly  this  was  a  ease  which,  if  not  properly  cared  for, 
might  have  terminated  unfavora])ly. 

Treatment. — Prognosis  is  decidedly  unfavorable  in  paraly- 
sis of  the  great  sciatic  nerve.  If  treatment  is  attempted,  it  is 
to  be  conducted  along  the  same  general  lines  as  in  femoral 
paralysis.  Particular  attention  should  be  given  to  conditions 
which  will  make  for  the  patient's  comfort,  and  as  soon  as  it 
is  evident  that  the  affection  is  not  progressing  favorably,  the 
subject  should  be  humanely  destroyed. 

Iliac  Thrombosis. 

This  condition  is  undoubtedly  of  more  frequent  occurrence 
than  we  are  wont  to  grant  when  one  considers  the  comparatively 
small  number  of  cases  that  are  actually  recognized  in  practice. 
It  does  not  follow,  however,  that  iliac  thrombosis  rarely  exists. 
Probably  in  the  majority  of  instances  there  is  insufficient  obstruc- 
tion of  the  lumina  of  vessels  to  provoke  noticeable  inconvenience. 
Or,  if  circulation  is  hampered  to  the  extent  that  function  is 
impaired  and  manifestations  are  observed  by  the  driver,  the 
subject  may  be  permitted  to  rest  a  few  days  and  p.-^rtial  resolu- 
tion occurs,  so  that  further  trouble  is  not  noticeable. 

As  judged  by  lesions  of  the  aorta  and  iliac  "arteries  in  dissect- 
ing subjects,  the  conclusion  that  arteritis  and  resultant  disorders 
are  of  rather  frequent  occurrence,  is  logical. 

Etiology. — Inflammation  of  the  vessel  walls  and  resultant 
prolifieration  of  tissue  together  with  the  accmnulation  of  clotted 
blood  becoming  organized,  serve  to  obstruct  the  lumen  of  the 
affected  artery.  The  cause  of  arteritis  is  unknown  in  many 
instances,  but  parasitic  invasion  and  contiguous  involvement  of 
vessels  in  some  inflammatory  injuries  are  etiological  factors. 

Symptomatology. — A  cluiracteristic  type  of  lameness  sig- 
nalizes iliac  thr()ml)osis  and  the  following  l)rief  abstract  from  a 


210  LAMENESS  OF  THE  HORSE 

contribution  on  this  subject  by  Drs.  IMerillat^,  clearly  portrays 
the  chief  symptoms : 

The  seizures  are  accompanied  with  profuse  sudation,  tremors, 


Fig-.  4S — Exposure  of  aorta  and  its  branches,  showing  location  of  thrombi  in 
numerous  places.  In  this  case  (same  as  Fig.  49)  Dr.  L.  A.  and  Dr.  Edward 
Merillat  found  the  cause  of  the  condition  to  be  due  to  sclerastomiasis. 

dilated  nostrils,  accelerated  respirations  and  otlier  symptoms  of 
pain  and  distress,  all  of  which,  together  with  the  lameness,  dis- 
appear as  rapidl}^  as  they  had  developed,  leaving  the  animal  in 

lAnnotation  on  Surgical  Items,  by  Drs.  L.  A.  and  Edward  Merillat,  Ameri- 
can Veterinary  Review,  Vol.  31,  page  S58. 


LAMENESS  IN  THE  HIND  LEG 


211 


an  apparently  perfect  state  of  health,  ready  to  fall  with  another 
attack  of  precisely  the  same  kind,  a.s  soon  as  enough  exercise  is 
forced  upon  it.  The  rectal  explorations  may  reveal  a  pulseless 
state  of  one  or  more  of  the  iliac  arteries  and  a  hardness  and 
enlargement  of  the  aortic  quadrifurcation,  but  sometimes  this 
palpation  fails  to  disclose  any  perceptihle  diminution  of  the  blood 
current  of  these  vessels.  The  obturation  being  incomplete,  it 
may  be  impossible  by  palpation  to  decide  that  thrombosis  really 


Fig.    I'.t— lllu.strativf 
by  Dr.  L.  A.  Merillat. 


ii'  Ihi'  aorta,  iliacs  and  branches.     Photo 


exists.  In  this  event  and,  in  fact,  in  all  eases,  the  clinical  sjanj)- 
toms  are  sufficiently  characteristic  to  make  a  diagnosis  without 
reservation.  It  cannot  be  mistaken  for  any  other  disease,  once 
properly  investigated.  Any  given  seizure  may  easily  be  mis- 
taken for  azoturia,  at  first,  but  a  better  examination  soon  ex- 
cludes that  disease. 

Prognosis  and  Treatment. — In  the  majority  of  instances, 
when  there  is  occasioned  serious  inconvenience,  the  outcome  is 
not  likely  to  be  favorable,  according  to  Moller.  Detachment  of 
a  portion  of  the  thrombus,  according  to  Hoare,  may  result  in 
the  lodgment  of  an  embolus  in  the  brain  or  kidneys.  The  latter 
authority  also  states  that  muscular  atrophy  may  occur  owing  to 
lack  of  blood  supply  in  some  of  these  cases.    Moller  states  that 


212  LAMENESS  OF  THE  HORSE 

moderate  exercise  or  work  stiini^lates  the  estahlishment  of  col- 
lateral circulation,  ^lassage  per  rectum  is  condemned  as  danger- 
ous by  Cadiot. 

Fracture  of  the  Patella. 

Etiolog-y  and  Occurrence. — Patellar  fractures  are  rarely  met 
with  in  the  horse  but  may  be  caused. by  falls  and  heavy  con- 
tusions. Violent  muscular  contraction,  it  is  said,  may  also  bring 
al)Out  the  same  condition. 

Symptomatology. — Fracture  may  be  transverse  or  vertical, 
and  depending  on  the  manner  in  which  the  bone  is  broken,  prog- 
nosis is  either  at  once  rendered  favorable  or  unfavorable.  The 
patella  performs  a  function  which  is  in  a  way  similar  to  that 
of  the  sesamoids  and  when  fractured,  complete  recovery  is  im- 
probable in  the  average  instance.  When  complete,  transverse 
fractures  permit  of  separation  of  the  parts  of  bone.  Tension  on 
the  straight  ligaments  below  and  contraction  of  the  quadriceps 
above  usually  cause  insuperable  difficulty  in  the  handling  of  this 
type  of  fracture  in  the  horse. 

Compound  fractures  as  well  as  multiple  or  comminuted  frac- 
tures occasionally  occur  and  these  constitute  injuries  which  are 
generally  considered  fatal,  although  Andrien,  according  to  Cadiot 
and  Almy,  succeeded  in  obtaining  complete  recovery  in  a  case  of 
compound  fracture  of  the  patella  and  the  horse  was  in  service 
and  almo.st  free  from  lameness  two  months  after  treatment  was 
'begun. 

No  difficulty  is  encountered  in  recognizing  the  fracture  of  the 
patella  because  of  the  exposed  position  of  the  bone.  Crepitation, 
and  in  some  cases  fissures,  may  be  easily  detected. 

Treatment. — In  simple  fracture,  when  treatment  is  thought 
a(lvisal)le,  the  subject  is  put  in  a  sling  and  kept  as  nearly  com- 
f()rta])le  as  possibk\  If  little  inflammation  exists,  the  application 
of  a  vesicant  two  or  three  weeks  after  the  injury  has  been  in- 
flicted will  be  helpful  and  serve  to.  hasten  repair. 

Bandages  or  mechanical  appliances  are  of  no  practical-  use  in 
the  handling  of  these  cases. 


LAMENESS  IN  THE  HIND  LEG  213 

Luxation  of  the  Patella. 

Etiology  and  Occurrence. — This,  the  iwost  common  luxation 
met  with  in  tlie  eijuine  sul)ject,  has  been  described  by  writers 
as  existing  in  many  forms.  Patellar  disarticulation  may  be  more 
practically  considered  as  momentary  and  fixed,  regardless  of  the 
position  taken  by  the  patella.  Described  under  the  title  of  false 
luxation  are  recorded  cases  wherein  the  quadriceps  (crural) 
muscles  become  contracted  in  such  manner  that  a  condition  sinui- 
lating-  true  disarticulation  of  the  patella  obtains.  Also,  some 
practictioners  report  cases  of  patellar  luxation  and  refer  to 
pseudo-luxations,  without  clearly  defining  the  conditions  which 
constitute  pseudo-luxation.  This  has  contributed  to  the  extant 
cause  of  misconception  as  to  actual  differences  between  luxation 
and  conditions  simulating  dislocation. 

Luxation  of  the  patella  is  a  condition  wherein  the  articular 
portions  of  the  femur  and  patella  assume  abnormal  relations 
whether  such  displacement  of  the  patella  be  momentary  and 
capable  of  spontaneous  reduction,  or  fixed  and  requiring  cor- 
rective manipulation.  Spasmodic  contraction  of  the  crural  mus- 
cles which  sometimes  retains  the  patella  in  such  position  that 
the  leg  is  rigidly  extended,  does  not  in  itself  constitute  luxation 
of  the  patella;  and  unless  this  bone  becomes  lodged  on  the  upper 
portion  of  a  femoral  condyle  or  laterally  displaced  out  of  its 
femoral  groove,  luxation  cannot  be  said  to  exist  in  the  horse. 
These  are  sub-luxations. 

Occasionally  one  may  observe  in  suckling  colts  outward  luxa- 
tion of  the  patella  wherein  there  is  history  of  navel  infection 
and  no  marked  evidence  of  rachitis  is  present.  Some  of  these 
cases  recover.  In  a  unilateral  involvement  of  this  kind  in  a 
three-month-old  mule  colt,  the  author  observed  a  case  wherein 
an  unfavorable  prognosis  was  given  and  destruction  of  the  sub- 
ject advised,  because  of  the  extreme  dislocation  of  the  patella. 
This  colt,  however,  was  not  destroyed  and  in  three  weeks  had 
apparently  recovered.  No  treatment  was  given  in  this  instance ; 
the  colt  was  allowed  the  run  of  a  small  pasture  with  its  dam  and 
in  time  it  matured,  becoming  a  sound  and  servicea])le  animal. 

Classification. — Two  forms  of  true  patellar  luxation  in  the 


214  LAMENESS  OF  THE  HORSE 

horse  may  be  considered;  one  wliicli  is  due  to  the  patella  becom- 
ing fixed  upon  the  internal  trochlear  rim  of  the  femur  and  the 
other  when  the  patella  slips  over  the  outer  rim  of  the  trochlea. 

The  first  form  is  known  as  upward  luxation  and  is  made  pos- 
sible by  rupture  of  the  mesial  (internal)  femeropatellar  ligament. 
According  to  Cadiot  and  Almy,  it  is  only  by  the  rupture  of 
this  ligament — the  femeropatellar — that  upward  luxation  may 
occur.  This  type  of  luxation  is  rarely  observed  and  is  usually 
due  to  violent  strain  and  abnormal  extension  of  the  stifle  joint. 

The  second  class,  outward  luxation,  occurs  in  colts  and  is, 
in  many  instances,  congenital.  This  form  of  luxation  is  also 
the  one  usually  seen  following  debilitating  diseases  such  as  influ- 
enza and  pneumonia. 

Vpivard  luxation  of  the  patella  is  characterized  by  the  stiff- 
extended  position  of  the  leg.  "When  the  patella  is  situated 
upon  the  inner  trochlear  rim,  the  tibia  must  be  extended  because 
of  the  traction  exerted  by  the  straight  ligaments.  Since  the 
stifle  and  hock  joints  extend  and  flex  in  unison,  there  is  presented 
also  an  extension  of  the  tarsus.  Extension  of  the  stifle  joint 
would  increase  the  distance  between  the  femoral  origin  of  the 
gastrocnemius  and  its  insertion  to  the  summit  of  fibular  tarsal 
bone  (calcis)  were  it  not  for  the  gastrocnemius  and  superficial 
flexor  (perforatus).  Extension  of  the  hock  in  upward  luxation 
of  the  patella,  permits  of  flexion  of  the  phalanges.  In  upward 
luxation,  then,  the  leg  is  extended  as  if  too  long,  but  the  pha- 
langes may  be  in  a  state  of  moderate  flexion.  If  the  foot  rests  on 
the  ground  when  the  extremity  is  not  flexed,  it  is  almost  impossi- 
ble for  the  subject  to  step  backward.  Because  of  immobilization 
of  the  stifle  and  hock  joints  in  upward  luxation,  the  subject  can 
walk  only  by  hopping  on  the  sound  leg  and  then  the  extremity 
is  flexed,  allowing  the  anterior  portion  of  the  fetlock  to  drag  on 
the  ground. 

In  some  cases  practitioners  are  called  to  attend  young  animals 
that  are  reported  to  be  "stifled"  (often  in  young  mules  that 
have  made  a  rapid  growth)  and  upon  arrival  the  only  noticeable 
symptom  of  preexisting  luxation  is  the  soiled  condition  of  the 
anterior  fetlock  region — evidence  of  its  having  been  dragged. 
Such  cases  may  be  styled  momentary  luxation,  whether  they  are 


LAMENESS  IN  THE  HIND  LEG  215 

due  to  a  weakened  condition  of  the  patellar  ligaments  or  spas- 
modic contraction  of  the  crural  muscles. 

In  upward  luxation,  reduction  is  effected  by  attempting  fur- 
ther extension  of  the  stitie  joint  and  at  the  same  time  the  patella 
is  pulled  outward,  off  the  internal  rim  of  the  trochlea.  This  is 
attempted  by  securing  the  subject  in  a  standing  position;  the 
sound  side  is  kept  against  a  wall  if  possible  and  a  rope  is  tied 
to  the  extremity  of  the  affected  leg.  Traction  is  exerted  upon 
tile  rope  and  at  the  same  time  force  is  directed  against  the  stifle 
joint  to  produce  further  extension  if  possible,  so  that  the  straight 
patellar  ligaments  may  relax  sufficiently  to  allow  the  patella  to 
be  dislodged  from  its  position  upon  the  inner  trochlear  lip.  Fail- 
ing in  this  manner  of  procedure,  the  affected  animal  is  to  be 
cast  and  anesthetized  with  chloroform.  The  relaxation  which 
attends  surgical  anesthesia  will  permit  of  reduction  of  the  dis- 
located bone  and  uuuiipulations  such  as  have  just  been  outlined 
may  be  employed. 

Following  reduction  in  the  average  case  it  is  essential  that  the 
subject  be  given  vigorous  exercise  for  a  few  minutes.  Reduction 
having  been  affected,  the  application  of  a  vesicant  over  the 
whole  patellar  region  is  customary. 

In  cases  of  habitual  luxation,  unless  the  ligaments  are  so  lax 
that  the  patella  may  be  displaced  laterally  over  the  inner  as 
well  as  the  outer  trochler  rims,  division  of  the  inner  straight 
patellar  ligament  will  correct  the  condition.  This  desmotomy 
has  been  advocated  by  Bassi,  and  good  results  in  appropriate 
cases  have  been  reported  by  Cadiot,  Merillat  and  Schumacher. 
This  operation  has  been  found  a  corrective  in  cases  of  outward 
luxation  as  well  as  those  of  upward  dislocation  of  the  patella 
when  resorted  to  before  the  trochleae  are  worn  from  frequent 
luxation. 

Outward  luxation  of  the  patella  is  occasioned  by  a  lax  condi- 
tion of  the  internal  femeropatellar  ligament  or  a  rupture  of  the 
same  so  that  the  patella  slips  over  the  outer  femoral  trochlear 
rim  and  permits  of  an  abnormal  flexion  of  the  stifle  joint.  The 
outer  trochlear  rim  being  the  smaller  of  the  two,  inward  luxation 
does  not  occur  in  the  horse.    With  the  patella  disarticulated  in 


21&  LAMENESS   OF  THE  HORSE 

this  manner,  the  action  of  the  quapriceps  femoral  group  of 
muscles  has  no  effect  on  the  stitie  joint  and,  therefore,  flexion  of 
this  articulation  occurs  as  soon  as  the  subject  attempts  to  sustain 
weight  and  the  leg  collapses  unless  weight  is  at  once  taken  up  by 
the  other  member  if  sound. 

As  a  rule,  the  reduction  of  this  form  of  luxation  is  not  diffi- 
cult. The  patella  may  be  pushed  inward  and  into  position  with- 
out manipulation  of  the  leg.  Retention  of  the  patella  in  position 
is  a  difficult  problem.  Bandaging  is  considered  impractical  and 
is  not  ordinarily  done  in  this  country.  Benard,  according  to 
Cadiot  and  Almy,  recommends  bandaging  with  a  heavy  piece  of 
cloth  in  which  an  opening  is  made  through  which  the  patella 
is  allowed  to  protrude,  and  by  turning  such  a  bandage  snugly 
about  the  stifle  several  times,  the  patella  is  held  in  position.  This 
bandage  should  be  kept  in  place  for  about  ten  days. 

In  young  and  rachitic  animals  outdoor  exercise  and  a  good 
nutritive  ration  for  the  subject  are  indicated.  Hypophosphites 
in  assimilal)le  form  may  be  beneficial,  and  vesication  of  the  pa 
tellar  region  contributes  to  recovery. 

Where  extreme  luxation  is  present  in  l)oth  stifles,  the  prog- 
nosis is  unfavorable.  In  such  cases,  degenerative  changes  may 
exist  and  in  some  instances  the  ligaments  are  so  diseased  and 
elongated  that  regeneration  is  impossible.  Williams^  reports  a 
case  where  bilateral  "floating"  (outward)  luxation  was  present 
and  extensive  degeneration  changes  affected  the  articulation. 

In  subjects  suffering  frequent  dislocation  of  the  patella  (ha- 
bitual luxation)  it  is  possible  in  some  cases,  to  prevent  its  occur- 
rence or  at  least  to  minimize  the  distress  occasioned  by  momen- 
tary luxation,  l^y  keeping  the  animals  in  wide  stalls  so  that 
"backing"  is  unnecessary.  In  some  nervous  subjects  that  seem 
to  be  suffering  from  cramp  of  the  crural  muscles,  the  difficulty 
and  pain  of  their  being  backed  out  of  narrow  stalls,  accentuates 
the  nervousness.  Sudation  and  restlessness  are  manifested  and 
the  subject  presents  a  clinical  picture  of  distress  and  fear  of  a 
painful  ordeal.  In  some  cases  of  this  kind,  complete  recovery 
takes  place  by  the  time  animals  are  five  or  six  years  of  age. 
One  should  avoid  keeping  such  subjects  in  narrow  stalls.     Pref- 


iW.  I..  Williams  in  American  Veterinary  Review,   Vol.  21,  page  452. 


[LAMENESS  IN  THE  HIND  LEG  217 

erably  patellar  desmotomy  should  l)e  performed  that  relief  may 
be  obtained  at  once. 

'  Luxations  attending  some  cases  of  influenza  recover  promptly 
when  subjects  are  kept  comfortably  confined  in  roomy  box-stalls. 
The  administration  of  stimulative  medicaments  such  as  nux  vom- 
ica and  the  application  of  an  active  blistering  agent  to  the 
patella  serve  to  hasten  recovery.  Dislocations  in  such  cases  are 
often  bilaterar  and  they  are  usually  momentary.  Reduction 
occurs  spontaneously,  as  a  rule,  and  the  subjects  are  not  occa- 
sioned much  distress  if  they  are  kept  quiet  for  a  few  days. 

Chronic  Gonitis. 

Etiolog"y  and  Occurrence. — Chronic  infiammation  of  tlie 
stifle  joint  is  met  with  following  acute  synovitis  due  to  strains 
and  concussion.  It  is  an  ailment  which  affects  heavy  horses  and 
particularly  animals  that  are  kept  at  work  on  paved  streets,  but 
this  does  not  explain  its  existence  in  animals  that  are  not  sub- 
jected to  work  likely  to  cause  concussion.  Berns^  considers  rheu- 
matism a  probable  cause  of  gonitis  and,  as  he  states,  the  dropsical 
form  of  affection  of  this  joint  is  not  ordinarily  attended  with 
manifestations  of  inconvenience  to  the  subject.  Gonitis  is  often 
bilateral  and  its  onset  is  insidious  in  many  instances. 

Symptomatology. — In  unilateral  gonitis  weight  is  not  borne 
I)y  the  affected  member.  There  is  noticeable  distension  of  the 
joint  capsule — a  characteristic  pendant  pouching  protrusion. 
When  both  stifles  are  affected  the  subject  frequently  shifts  the 
weight  from  one  limb  to  the  other.  Lameness  comes  on  gradu- 
ally and  during  the  incipient  stages  may  be  intermittent  but  it 
progressively  increases  so  that  in  time  affected  animals  become 
useless.  In  bilateral  affections  animals  drag  the  toes  because 
of  the  pain  incident  to  flexing  the  stifles.  This  is  particularly 
evident  when  the  subject  is  made  to  trot.  iVs  the  disease  pro- 
gresses, atrophy  of  the  quadriceps  femoris  muscles  becomes  pro- 
nounced and  as  destructive  changes  involving  the  articular  car- 
tilages take  place.  The  su])ject  becomes  more  lame  and  eventu- 
ally is  rendered  incapable  of  service. 


iGeo.  H.  Berns,  D.  V.  S.,  report,  American  Veterinary  Medical  Association, 
1912,  page  238. 


218 


LAMENESS  OF  THE  HORSE 


Upon  manipulation  of  the  patellar  I'egion,  one  is  impressed 
with  the  fact  that  hyperesthesia  does  not  exist  in  proportion  to 
the  pain  manifested  during  locomotion.  In  some  cases  a  gel- 
atinous swelling  is  present  and  may  be  detected  by  palpating 


Fig.  50 — Cliionic  gonitis.  The  knuckling  which  results  from  long  cuntimKil 
inactivity  of  the  crural  muscles  in  chronic  cases  is  marked  in  this  instance. 
Photo  by  Dr.  L.  A.  Merillat. 

between  the  straight  ligaments  of  the  patella.  "Williams,  Hughes, 
Merillat,  liadley  and  others  have  directed  attention  to  the  exist- 
ence of  floating  masses  {corpora  orijzoidea)  in  the  synovial  cap- 
sule of  this  joint  in  gonitis,  and  as  with  all  cases  of  arthritis, 
irreparable  damage  is  often  done  the  articular  cartilages  during 
the  course  of  the  ailment. 


ILAMENESS  IN  THE  HIND  LEG 


219 


Treatment. — No  effective  method  is  as  yet  known  which 
will  control  this  condition  dnring  its  incipiency.  The  disease 
progresses,  and  more  or  less  damage  is  done  the  affected  parts 
in  the  course  of  months  or  even  years  in  some  cases  before  sub- 


Fig.  51 — Gonitis.     Showing  position  assumed  in  such  cases  because  of  pain 
occasioned.     Photo  by  Dr.  C.  A.  McKilHp. 


jects  are  rendered  hopelessly  crippled.  When  recognized  early 
(before  chronic  gonitis  exists)  aspiration  of  the  synovia  and  the 
injection  of  diluted  tincture  of  iodin  might  prove  beneficial  in 
cases  of  .synovial  distension.  Chronic  gonitis  is  considered  an 
incurable  affection  and  as  soon  as  subjects  manifest  evidence  of 
distress  from  this  condition  they  should  by  all  means  be  taken 
from  work.  Firing  and  vesication  have  not  been  productive  of 
beneficial  results. 


220  LAMENESS  OF  THE  HORSE 

Open  Stifle  Joint. 

Anatomy  of  the  Joint  Capsule. — This  joint  capsule  is  thin 
and  very  capacious.  On  the  patella  it  is  attached  around  the 
margin  of  the  articular  surface,  but  on  the  femur  the  line  of 
attachment  is  at  a  varying  distance  from  the  articular  surface. 
On  the  medial  side  it  is  an  inch  or  more  from  the  articular  car- 
tilage; on  the  lateral  side  and  above,  about  half  an  inch.  It 
pouches  upward  under  the  quadriceps  femoris  for  a  distance  of 
two  or  three  inches,  a  pad  of  fat  separating  the  capsule  from  the 
muscle.  Below  the  patella  it  is  separated  from  the  patellar  liga- 
ments by  a  thick  pad  of  fat,  but  interiorly  it  is  in  contact  with 
the  femerotibial  capsules.  The  joint  cavity  is  the  most  extensive 
in  the  body.  It  usually  communicates  v.-ith  the  medial  sac  of 
the  femerotibial  joint  cavity  by  a  slit-like  opening  situated  at 
the  lowest  part  of  the  medial  ridge  of  the  trochlea.  A  similar, 
usually  smaller,  communication  with  the  lateral  sac  of  the  fe- 
merotibial capsule  is  often  found  at  the  lowest  part  of  the  lat- 
eral ridge.     (Sisson's  Anatomy.) 

Thus  it  is  seen  that  because  of  its  frequent  communication 
with  the  other  parts  of  this  large  synovial  membrane,  a  wound 
which  opens  the  external  portion  of  the  femerotibial  capsule 
may  be  the  cause  of  contamination  and  resultant  infectious  ar- 
thritis of  the  whole  stifle  joint.  Because  of  the  distance  between 
the  most  dependent  part  of  the  femerotibial  articulatioii  and 
the  summit  of  the  patella,  one  may  misjudge  the  exact  location 
of  the  lowermost  part  of  this  portion  of  the  capsular  ligament 
of  the  stifle  joint  and  thereby  fail  at  once  to  appreciate  the  seri- 
ousness of  calk  wounds  in  this  region. 

Etiology  and  Occurrence. — AVounds  to  the  patellar  region 
are  of  rather  frequent  occurrence,  and  because  of  the  compara- 
tively unprotected  position  of  these  structures,  the  capsular  liga- 
ments of  the  stifle  joint  may  be  perforated  as  a  result  of  violence 
in  some  form.  Calk  wounds  which  penetrate  the  tissues  in  the 
immediate  region  of  the  lower  portion  of  the  external  part  of 
the  femerotibial  capsule  sometimes  result  in  open  joint  because 
of  tissue  necrosis  resulting  from  the  introduction  of  infection. 
Contused  wounds  sometimes  destroy  the  skin  and  fascia  over 


LAMENESS  IN  THE  HIND  LEG  221 

large  areas  on  the  lateral  patellar  region  and  because  of  subse- 
quent sloughing  of  tissue  due  to  infection  as  well  as  to  the  man- 
ner in  which  such  wounds  are  inflicted,  septic  arthritis  subse- 
quently occurs.  Penetrant  wounds,  such  as  may  be  caused  by  a 
fork  tine  may  not  result  in  infection;  if  infectious  material  is 
introduced  an  infectious  arthritis  does  not  necessarily  follow, 
though  such  cases  should  be  considered  as  serious  from  the  out- 
set. ^  ^' 

Symptomatology. — The  pathognomonic  symptom  of  open 
stifle  jouit  is  the  profuse  escape  of  synovia,  indicating  perfora- 
tion of  the  synovial  capsule;  by  means  of  a  probe  the  wound 
may  be  explored  in  a  way  that  will  clearly  reveal  the  nature  of 
the  injury. 

After  a  few  days  have  elapsed  in  cases  where  considerable 
infection  has  taken  place,  there  is  manifestation  of  pain  as  in 
all  cases  of  infective  arthritis.  Hughes^  gives  an  excellent  de- 
scription of  the  clinical  aspect  of  arthritis  Avhich  applies  here: 

Acute  arthritis  begins  like  an  ordinary  attack  of  synovitis. 
In  joints  other  than  the  pedal  and  pastern,  there  is  sudden  and 
extensive  swelling,  which  at  first  is  intra-articular,  succeeded  by 
extra-articular  tumefaction,  and  accompanied  by  violent  lame- 
ness. The  pain  soon  becomes  intense  and  agonizing.  There  is 
severe  constitutional  disturbance,  the  temperature  ranging  from 
104  to  106  degrees  and  the  pulse  from  60  to  72.  Painful  con- 
vulsions of  the  limb  occur,  shown  by  involuntary  spasmodic  ele- 
vations due  to  reflex  irritation  of  the  muscles.  There  is  loss 
of  appetite,  rapid  emaciation,  the  flank  is  tucked  up  and  the 
back  arched.  In  from  three  to  six  days,  the  tumefaction  around 
the  joint  tends  to  soften  at  a  particular  place,  and  bursts,  and 
a  discharge  that  is  sometimes  of  a  sanious  character,  mixed  with 
synovia,  escapes.  Great  exhaustion  at  times  supervenes,  and 
if  the  joint  is  an  important  one,  the  horse  lies  or  falls  and  is 
unable  to  rise. 

Treatment. — In  small  puncture  Avounds  the  immediate  appli- 
cation of  a  vesicating  ointment  has  given  good  results,  but  Avhen 
infection  has  taken  place  to  such  extent  that  the  animal  mani- 
fests evidence  of  intense  pain,  and  lameness  is  marked  and  local 
swelling  and  hyperesthesia  are  great,  vesication   is  contraindi- 


ijoseph  Hughes.  M.   R.   C.  V.   S.,   in  the  Chicago   Veterinary  College  Quar- 
terly Bulletin,  Vol.  10,  page  15. 


222  LAMENESS  OF  THE  HORSE 

eated.  In  such  instances  the  exterior  of  the  wound  and  its  mar- 
gins should  be  prepared  as  in  similar  affections  of  other  joints.  A 
quantity  of  synovia  is  then  aspirated  by  means  of  a  small  tro- 
car and  care  should  be  taken  to  observe  all  due  aseptic  precau- 
tions. Subsequently  the  injection  of  from  four  to  six  ounces 
of  a  mixture  of  tincture  of  iodin,  one  part  to  ten  parts  of  gly- 
cerin, and  gentle  massage  of  the  joint  immediately  after  the 
injection  has  been  made,  serves  to  check  the  infective  process 
in  some  cases. 

The  subject  should  be  cared  for  as  has  been  previously  sug- 
gested in  arthritis — proper  provisions  for  comfort  being  made. 
Good  nursing  is  always  essential  to  a  successful  issue.  However, 
the  author  cannot  view  cases  of  open  stifle  joint  with  the  same 
optimism  concerning  their  course  and  outcome  that  is  expressed 
by  a  number  of  writers  on  this  subject.  It  is  a  grave  condition 
wherein  the  prognosis  should  be  given  advisedly 

Fracture  of  the  Tibia. 

Etiology  and  Occurrence. — Because  of  its  exposed  position 
to  kicks,  and  its  lack  of  protection  by  heavy  musculature  (espe- 
cially on  its  inner  surface),  there  is  afforded  ample  opportunity 
for  frequent  injury  to  the  tibia.  Fractures  are  complete  and 
varying  as  to  nature,  or  incomplete.  The  heavy  tibial  fascia 
affords  sufficient  protection  so  that  fissures  without  entire  solu- 
tion of  continuity  of  the  bone  may  occur  from  violence  to  which 
this  part  is  often  subjected.  Moller  classes  tibial  fracture  as 
ranking  second  in  frequency — pelvic  fracture  being  more  often 
mot  with  in  horses.  This  does  not  apply  in  our  country  as  pha- 
langeal and  metacarpal  and  even  metatarsal  fractures  are  ob- 
served in  more  instances  than  are  such  injuries  to  the  tibia.  The 
tibia  is  occasionally  broken  at  its  middle  and  lower  thirds,  but 
malleolar  fractures  are  not  common. 

Symptomatology. — AVhen  fracture  is  complete  and  all  sun- 
port  is  removed,  the  leg  dangles,  and  the  nature  of  the  injury 
is  so  obvious  that  there  is  no  mistaking  its  identity.  However, 
in  case  of  incomplete  fracture  one  needs  to  base  all  conclusi(ms 
upon  the  history  of  the  case,  evidence  of  injury,  or  other  knowl- 


(LAMENESS  IN  THE  HIND  LEG  223 

edge  of  the  character  of  violence  to  which  this  bone  has  l)een 
exposed.  For  without  the  presence  of  crepitation  (even  by  ex- 
cluding other  possible  causes  for  the  pronounced  lameness  which 
characterizes  some  of  these  cases)  we  can  only  resort  to  the 
knowledge  which  experience  has  taught  that  fracture  may  be 
deemed  probable  in  many  injuries  to  the  til)ial  region.  Con- 
sequently, we  are  to  look  upon  all  injuries  that  affect  the  tibia 
as  being  fractures  of  some  sort  when  there  is  either  local  evidence 
of  the  infliction  of  violence  or  whenever  marked  lameness  attends 
such  injuries,  unless  there  is  positive  indication  that  no  fractures 
exist. 

A  careful  examination  of  parts  of  the  tibia,  i.  e.,  noting  the 
amount  and  painfulness  of  swellings,  exploration  with  the  probe, 
and  observations  of  the  course  taken  in  any  given  case,  will 
determine  the  exact  nature  of  injuries.  Such  examination  needs 
to  extend  over  a  period  of  a  week  or  in  some  instances  two  or 
three  weeks  may  pass  before  the  true  state  of  affairs  is  apparent. 
In  the  meanwhile,  cases  are  to  be  handled  as  though  tibial  frac- 
ture certainly  existed. 

Prognosis. — Prediction  of  the  outcome  in  tibial  fracture  is 
somewhat  presumptuous,  but  in  the  majority  of  cases  in  mature 
subjects  fatality  results.  Cadiot^  however,  views  this  condition 
with  more  optimism  than  have  American  practitioners.  Wliile 
he  considers  the  condition  grave,  in  citing  case  reports  of  suc- 
cessful treatment  by  d'Arboval,  D'uchemin,  Leblanc,  and  others, 
his  conclusion  is  that  many  practitioners  erroneously  consider 
fractures  of  the  tibia  as  incurable. 

The  method  of  handling  these  cases  by  Leblanc  is  as  follows : 
The  subject  is  placed  in  a  sling;  a  pit  is  excavated  below  the 
affected  member  so  that  a  heavy  weight  may  be  attached  to  the 
extremity;  splints  are  applied  to  each,  side  of  the  leg,  which  is 
padded  with  oakum,  and  this  is  kept  in  position  by  means  of 
bandages  covered  with  pitch;  The  outer  splint  extends  from 
the  hoof  to  the  stifle  and  the  inner  one  from  the  hoof  to  the 
upper  third  of  the  leg.  This  method  in  the  hands  of  Leblanc 
has  been  successful  in  several  instances,  according  to  Cadiot. 


^Traite  de  Therap.  Cliir,  Cadiot  et  .41my,  Tome  second,  page  480, 


224  LAMENESS  OF  THE  HORSE 

In  a  foal  the  author  has  in  one  instance  succeeded  in  obtain- 
ing complete  recovery  in  a  simple  fracture  of  the  lower  third 
of  the  tibia  where  the  only  support  given  the  broken  bone  was 
a  four-inch  plaster-of-paris  bandage  which  was  adjusted  above 
the  hock.  Below  the  tarsus  a  cotton  and  gauze  bandage  was  ap- 
plied to  prevent  swelling  of  the  extremity.  In  this  instance 
(an  emergency  case  in  which  materials  that  are  not  to  be  recom- 
mended were  necessarily  employed)  recovery  took  place  within 
thirty  days. 

As  has  been  mentioned  in  the  consideration  of  radial  frac- 
tures, heavj^  leather  is  better  suited  for  immobilization  of  these 
parts  than  a  cast  or  other  rigid  splint  materials.  Mature  ani- 
mals may  be  expected  to  resist  the  immobilization  of  the  hind 
legs  because  of  the  normal  manner  of  flexion  of  the  tarsal  and 
stifle  joints  in  unison.  Therefore,  the  application  of  rigid  splints 
to  the  leg  and  including  the  hock  is  productive  of  disastrous 
results  in  some  eases. 

The  application  of  cotton  and  bandages  to  pad  the  member 
and  the  adjustiug  of  heavy  leather  splints  on  either  side  of  the 
leg,  and  retaining  them  in  position  with  four-inch  gauze  band- 
ages will  prove  more  nearly  satisfactory  than  some  other  meth- 
ods employed.  Prognosis  is  unfavorable,  however,  in  most  cases 
of  compound  fracture  and  recovery  is  improbable  when  the 
upper  portion  of  the  tibia  is  broken. 

Rupture  and  Wounds  of  the  Tendo  AchilHs. 

Etiology  and  Occurrence. — Cases  are  recorded  by  Uhlridi 
in  which  rupture  has  followed  degenerative  changes  affecting 
the  tendo  Achillis.  Not  infrequently,  the  result  of  a  trauma, 
division  of  the  tendo  Achillis  occurs.  IMoller  states  that  rupture 
of  this  tendon  may  be  due  to  jumping,  in  riding  horses  and  in 
draught  horses,  in  their  efforts  to  avoid  slipping.  In  runaways, 
it  sometimes  occurs  where  sharp-edged  implements  are  l)Ounced 
against  the  legs  in  such  fashion  tliat  division  of  tlie  tendon  re- 
sults. 

Symptomatology.— AVith  division  of  the  tendo  Aeliillis  or 
of  the  musculature  of  the  gastrocnemii  and  the  superficial  flexor 


LAMENESS  IN  THE  HIND  LEG  225 

(perforatiis),  there  remains  nothing  to  inhibit  tarsal  flexion 
except  the  deep  flexor  tendon  (perforans)  and  this  does  not  sup- 
port the  leg.  When  attempt  is  made  to  sustain  weight  with  the 
affected  member,  abnormal  flexion  of  the  tarsus  takes  place  and 
the  hock  sinks  almost  to  the  ground.  The  symptoms  are  so  char- 
acteristic that  recognition  is  always  easy  even  in  case  no  wound 
of  the  skin  exists. 

Prognosis. — Spontaneous  recoveries  occur  and  such  cases 
are  reported  by  Bouley  who  is  quoted  by  Cadiot  as  having  ob- 
served division  of  the  tendo  Achillis  due  to  a  sword  wound 
wherein  at  the  end  of  four  mouths  recovery  was  complete.  Di- 
vision of  this  tendon  in  brood  mares  has  been  practiced  by  the 
early  settlers  of  parts  of  the  United  States  for  the  purpose  of 
preventing  their  straying  too  far  from  home.  In  such  instances 
one  leg  only  was  so  mutilated  and  in  most  instances,  it  is  re- 
ported that  spontaneous  recovery  took  place. 

In  unilateral  involvement  without  complications,  the  prog- 
nosis is  not  unfavorable  if  provisions  for  giving  necessary  atten- 
tion are  available. 

Treatment.— Tlie  subject  is  to  be  confined  in  a  sling  and  the 
member  bandaged  and  supported  by  means  of  leather  splints. 
Immobilization  as  for  fracture  is  not  necessary  but,  nevertheless, 
movement  is  to  be  restricted  as  much  as  possible.  In  case  of 
open  wounds,  tiie  exposed  tissues  are  cared  for  along  general 
surgical  lines.  Where  the  divided  parts  of  the  tendon  are  main- 
tained in  fairly  close  and  constant  relation,  granulation  of  tissue, 
sufficient  to  sustain  weight  takes  place  in  from  six  weeks  to  three 
months. 

Spring-Halt.   ( String-Halt. ) 

Occurrence. — This  condition  is  a  myoclonic  affection  of  the 
hind  leg  which  is  discussed  in  works  on  theory  and  practice 
under  the  head  of  neuroses,  but  the  cause  or  causes  have  not 
been  established.  Theories  that  heredity  is  responsible  have 
their  supporters  and  advocates  of  hypotheses  attributing  it  to 
disease  of  the  sciatic  nerve,  patellar  subluxation,  fascial  con- 
traction of  various  muscles,  "dry  spavin"  (tarsal  arthritis), 
iliac  exostoses,  disease  of  the  foot  and  contraction  of  the  hoof. 


226 


LAMENESS  OF  THE  HORSE 


are  on  record  in  veterinary  literature.  This  ailment  affects  old 
horses  more  frequently  than  it  does  young  and  is  seen  in  all 
breeds  of  animals  including  mules. 

Symptomatology. — This   disease   develops   slowly,   and  pro- 
gressively increases  in  severity  as  a  rule,  Init  does  not  ordinarily 


Fig.  52— Spring-halt. 

constitute  cause  for  rendering  an  animal  unserviceable.  While 
the  affection  is  sometimes  l)ilateral  (occasionally  affections  of 
the  forelegs  are  reported)  and  the  extreme  flexion  of  the  legs 
in  the  spasmodic  manner  which  characterizes  spring-halt,  cause 
great  waste  of  energy  during  locomotion,  yet  such  cases  are 
rare.  Usually  the  ailment  is  markedly  evinced  when  subjects 
are  first  taken  from  the  stable,  but  as  they  are  exercised  the 
manifestation  diminishes,  and  in  many  instances  it  completely 
subsides.  The  condition  is  generally  more  noticeable  when  the 
subject  is  made  to  step  backward.     In  some  animals  there  is 


L.AMENESS  IN  THE  HIND  LEG  227 

marked  abduction  at  the  time  flexion  occurs  and  in  singular 
instances  the  spasmodic  contraction  is  so  violent  that  the  subject 
falls  to  the  ground  as  a  result  of  the  peculiar  flexion  of  the  leg. 
In  severe  cases  of  "scratches"  or  chemical  irritation  of  the 
extremity,  the  legs  are  abnormally  flexed  in  a  manner  which 
simulates  spring-halt,  but  because  of  the  evident  injury  of  the 
parts  this  is  not  likely  to  confuse.  Since  all  facts  concerning 
etiological  agencies  are  surrounded  with  so  much  obscurity,  clas- 
sification does  not  lend  any  particular  assistance  in  the  consid- 
eration of  this  ailment. 

Prog-nosis. — One  cannot  intelligently  give  a  prognosis  in 
these  cases  if  forecast  is  expected  to  state  the  exact  course  fol- 
lowing treatment.  However,  in  a  general  way,  cases  of  recent 
affection  are  thought  more  favorable  than  are  those  of  long  stand- 
ing or  in  old  animals  where  myositis  and  other  muscular  and 
fascial  affections  exist  owing  to  years  of  hard  service. 

Treatment. — No  known  line  of  medicinal  treatment  is  of 
service,  nor  is  any  particular  surgical  operation  to  be  considered 
dependable  for  obtaining  relief.  Operations  of  almost  every  con- 
ceivable nature  have  been  tried  with  the  hope  of  securing  recov- 
ery in  spring-halt  but  under  no  condition  can  the  practitioner 
as  yet  be  reasonably  certain  of  effecting  permanent  relief  in  any 
case.     Treatment  is,  therefore,  entirely  empirical. 

Neurectomies  have  been  performed  and  recoveries  follo\\ing 
were  attributed  thereto;  fascial  divisions  in  the  crural  region 
have  been  done  \^•ith  good  results  and  this  manner  of  treatment 
has  its  favorers.  Advocates  of  tenotomies,  likewise,  are  to  be 
found.  Consequently,  one  may  summarize  thus :  Spring-halt  is 
a  disease  of  unknown  origin — the  exact  cause  has  not  been  deter- 
mined ;  therefore,  all  treatment  is,  in  a  way,  experimental.  The 
recommendation  of  any  given  procedure  in  handling  cases  must 
then  be  a  matter  of  opinion  based  either  upon  practical  experi- 
ence or  knowledge  of  the  experiences  of  others.  Divisions  of  the 
lateral  digital  extensor  (peroneus)  below  the  tarsus  near  its 
point  of  insertion  to  the  extensor  of  the  digit  is  recommended 
here  because  it  is  followed  by  a  percentage  of  recoveries  that  is 
as  large  as  in  any  other  method  of  treatment  and  the  operation 


228 


LAMENESS  OF  THE  HORSE 


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% 

Li 

Fig-.   53— Lateral   (external)   view  of  tarsus  showing  effects  of  generalized 
tarsitis. 


LAMENESS  IN  THE  HIND  LEG  229 

is  not  difficult  to  perform  nor  is  its  performance  fraught  with 
any  dangerous  complications.  In  selected  subjects  about  fifty 
per  cent  of  cases  recover  in  from  two  to  six  weeks  following  this 
operation. 

Open  Tarsal  Joint. 

Like  the  tibia  the  hock  is  exposed  to  frequent  injuries  and  in 
some  cases  wounds  perforate  the  joint  capsule.  When  due  to 
calk  wounds  where  horses  are  kicked,  the  injury  is  often  on  the 
side  of  the  tarsus  (medial  or  lateral)  and  such  wounds  not  in- 
frequently result  in  infectious  arthritis.  Horses  sometimes  jump 
over  wire  fences  and  wounds  are  inflicted  which  constitute  ex- 
tensive laceration  of  the  joint  capsule.  In  firing  for  bone  spavin, 
where  a  deep  puncture  is  made  very  near  the  tibial  tarsal  (tibio- 
astragular)  joint  if  infection  gains  entrance,  serious  and  general- 
ized infection  of  the  open  joint  cavity  supervenes  in  some  cases. 

Symptomatology. — There  is  no  marked  difi^erence  in  the  con- 
stitutional disturbances  which  are  occasioned  in  this  condition 
and  those  encountered  in  other  cases  of  septic  arthritis  (previ- 
ously considered  herein)  except  that  there  is  a  difference  in  tlie 
degree  of  resultant  derangement  and  local  tissue  changes. 
Chiefly,  because  of  the  difficulty  encountered  in  keeping  the 
hock  joint  in  an  aseptic  condition  or  securely  bandaged,  open 
tarsal  joint  constitutes  a  more  serious  condition  than  a  similar 
affection  of  the  fetlock.  Otherwise,  a  very  similar  condition  ob- 
tains and  the  same  diagnostic  principles  serve  here  that  have 
been  described  on  page  110  in  considering  open  fetlock  joint. 

Treatment. — The  same  plan  that  is  described  in  detail  for 
treatment  of  similar  conditions  aft'ecting  Mie  fetlock  joint  is  indi- 
cated in  this  affection.  Exceeding  care  must  be  exercised  in 
bandaging  the  hock,  however,  lest  the  animal  be  so  irritated  that 
in  the  extreme  flexion  of  the  tarsus  which  is  often  caused  by 
bandaging,  the  wound  dressings  may  be  completely  deranged. 
A  wide  gauze  bandage  material  is  most  satisfactory;  cotton  of 
long  fiber  is  separated  in  thin  layers  and  wound  about  the  hock, 
extending  from  the  site  of  injury  to  a  point  about  six  inches 
proximal  to  the  summit  of  the  os  calcis.    By  using  an  abundance 


230  LAMENESS  OF  THE  HORSE 

of  cotton  in  this  way,  it  will  not  be  found  necessary  to  apply  the 
bandages  very  snugly;  with  a  four-inch  gauze  bandage  material, 
which  is  supported  above  the  cap  of  the  hock  and  brought  across 
the  anterior  face  of  the  tarsus  in  a  diagonal  manner,  a  comfort- 
able and  very  serviceable  protective  dressing  is  provided  for. 
Animals  so  treated  will  not  ordinarily  resist  because  of  pressure 
from  the  bandages.  Pressure  is  unavoidable  in  the  use  of  ad- 
hesive dressings  or  where  careful  attention  is  not  given  the  man- 
ner of  applying  cotton  to  the  parts.  Such  methods  are  sure  to 
result  disastrouslj^  But  if  subjects  are  kept  quiet  after  the 
parts  have  been  properly  bandaged,  no  difficulty  is  encountered 
in  maintaining  asepsis  in  an  uninfected  wound.  Recovery  takes 
place  in  favorable  cases  in  from  three  weeks  to  three  months,  de- 
pending on  the  nature  and  extent  of  injuries  inflicted. 

Fracture  of  the  Fibular  Tarsal  Bone   (Calcaneum.) 

Etiology  and  Occurrence. — This  condition  though  rarely  met 
with  in  the  horse,  is  the  result  of  violent  strain  upon  the  os 
caleis  by  the  gastrocnemius  and  superficial  flexor  tendons  in 
efforts  put  forth  by  animals  in  attempts  to  regain  a  footing  when 
the  hind  feet  slip  forward  under  the  body,  or  in  jumping  and 
in  falls  or  direct  contusion  by  heavy  bodies.  Hoare^  reports  a 
case  of  a  mare  that  had  produced  fracture  in  jumping. 

Fracture  of  the  other  tarsal  bones  are  very  seldom  observed 
but  may  be  occasioned  by  contusions  wherein  multiple  or  com- 
minuted fractures  are  produced,  such  as  are  to  be  seen  in  small 
animals.  Fracture  of  the  tibial  tarsal  bone  (astragalus)  is  to  be 
observed  as  a  complication  in  luxations  of  the  tarsal  joint  and, 
according  to  Cadiot,  the  other  tarsal  bones  may  likewise  suffer 
fracture  in  luxations  of  the  hock. 

Symptomatology. — Great  pain  attends  this  accident  accord- 
ing to  the  observations  given  in  recorded  cases.  In  the  case 
cited  by  Hoare  the  animal  evinced  great  pain  and  uneasiness;  the 
hock  was  unduly  flexed;  the  calcaneum  was  displaced  forward; 
and  marked  crepitation  was  present.     A  portion  of  the  body  of 


IE.   W^allis    Hoaro,   F.   R.    C.   V.    S.,    American    Veterinary   Review,    Vol.    27, 
page  1189. 


LAMENESS  IN  THE  HIND  LEG  ?31 

the  calcaneum  was  protruding  through  the  perforated  skin.  The 
animal  was  destroyed  and  the  bone  was  found  l)roken  in  three 
pieees. 

Sinee  the  support  for  the  tendo  Achillis  is  removed  in  such 


1 


Tuber  calcis 


Lateral  malleolus 


Short  liitiral  ligament E_      jp        \ 

/ 


1 


/  Short  meiiial  ligavjeittn 


''rochlea  of  tibial  tarsal 
bone 


T.f.—        .    ^- 
T.4  - 


T  t. 

Dorsal  lii/ament 


Mt.  IV        ,  _  -  -  r.  .3 

. Mt.  Ill 


Fig.  54 — Right  hock  joint.  Viewed  from  the  front  and  slightly  laterally 
after  removal  of  joint  capsule  and  long  collateral  ligaments.  T.  t.,  Tibial 
tarsal  bone  (distal  tuberosity).  T.  c,  central  tarsal  bone.  T.  3.  Ridge  of 
third  tarsal  bone.  T.  f.  Fibular  tarsal  bone  (distal  end).  T.  4.  Fourth  tarsal 
bone.  Mt.  Ill,  Mt.  IV.  Metatarsal  bones.  Arrow  points  to  vascular  canal. 
(From  Sisson's  "Anatomy  of  the  Domestic  Animals.") 

fracture  and  no  leverage  on  the  metatarsus  obtains,  it  naturally 
follows  that  any  attempt  to  sustain  weight  must  result  in  extreme 
flexion  of  the  hock  and  descent  of  this  part  in  a  manner  similar 
to  cases  of  rupture  or  division  of  the  Achilles'  tendon.  The  two 
conditions  should  not  be  confused,  however,  as  the  parts  may  be 


232  LAMENESS  OF  THE  HORSE 

definitely  outlined  by  palpation  and  the  slack  condition  of  the 
tendon  and  displaced  summit  of  the  calcaneum,  which  charac- 
terize fracture  of  the  fibular  tarsal  bone,  are  easily  recognized. 
Treatment. — Prognosis  is  unfavorable  in  the  majority  of 
cases,  but  should  attempts  at  treatment  be  undertaken  in  young 
and  quiet  mares  which  might  prove  valualjle  for  breeding  pur- 
poses in  case  of  imperfect  recovery,  they  should  be  put  in  slings 
and  the  member  is  to  be  immobilized  as  in  tibial  fracture.  Au- 
thorities are  agreed  that  prognosis  is  entirely  unfavoralile  in 
mature  animals,  when  the  case  is  viewed  from  an  economic  stand- 
point. 

Tarsal  Sprains. 

Etiology  and  Occurrence. — The  hock  joint  is  often  sul)jected 
to  great  strain  because  of  the  structural  ju^ture  of  this  part  and 
its  relation  to  the  hip  as  well  as  the  manner  in  which  the  tarsus 
functionates  during  locomotion.  That  ligamentous  injuries  ow- 
ing to  sprain  frequently  occur  and  attendant  periarticular  in- 
flammations with  subsequent  hypertrophic  changes  follow,  is  a 
logical  inference.  Fibrillary  fracture  of  the  collateral  ligaments 
may  take  place  in  falls  or  when  animals  make  violent  efforts 
to  maintain  their  footing  on  slippery  streets.  In  expressing 
opinions  concerning  the  frequency  with  which  the  hock  is  found 
to  be  the  seat  of  trouble  in  lameness  of  the  pelvic  members,  dif- 
ferent writers  place  the  percentage  of  hock  lameness  at  from 
seventy-five  to  ninety  per  cent.  And  when  one  considers  the 
possibility  that  a  goodly  proportion  of  cases  of  tarsal  exostis  are 
the  outcome  of  sprains,  the  occurrence  of  tarsal  sprains  may  be 
more  generally  admitted. 

Symptomatology. — A  mixed  type  of  lameness  is  present  and 
the  nature  of  the  impediment  varies,  depending  upon  the  loca- 
tion of  the  injury.  Sprains  of  the  mesial  tarsal  ligaments  cause 
lameness  some^\hat  similar  to  that  of  spavin.  However,  in  es- 
tablishing a  diagnosis,  local  evidence  in  these  cases  is  of  greater 
significance  than  the  manner  of  locomotion.  During  the  acute 
stage  of  inflammation  there  is  to  be  detected  local  hyperthermia, 
some  hyperesthesia  and  a  little  swelling.  Later,  when  resolution 
is  not  prompt,  considerable  swelling  (or  perhaps  correctly  speak- 


LAMENESS  IN  THE  HIND  LEG  233 

ing,  an  iiulurated  enlargement)  variable  in  size  is  developed. 
In  some  cases  the  entire  tarsal  region  becomes  greatly  enlarged 
and  this  swelling  is  very  slowly  absorbed  in  part  or  completely. 
Sneh  snb-acnte  cases  are  observed  dnring  the  winter  season  and 
particularly  where  subjects  are  kept  in  tie  stalls  without  exercise 
for  weeks  at  a  time. 

Treatment. — Attention  slionld  be  directed  toward  i-elief  foi- 
the  animal  in  all  acute  inflammations.  Local  applications  of 
heat  are  helpful  and,  of  course,  rest  is  essential.  Towels  that 
are  wrung  out  of  hot  water  and  held  in  position  by  means  of  a 
few  turns  of  a  loose  bandage  and  this  covered  with  an  imper- 
vious rubber  sheet,  will  serve  as  a  practical  means  of  application 
of  hydrotherapy.  Following  this  when  conditions  improve,  as 
in  the  handling  of  all  similar  cases,  counterirritation  is  indi- 
cated. 

When  proper  care  is  given  at  the  onset  and  where  injury  does 
not  involve  too  much  ligamentous  tissue,  recovery  takes  place 
in  a  few  weeks  but  in  some  cases  which  occur  during  the  winter 
season  in  farm  horses,  complete  recovery  does  not  result  until 
several  months  have  passed. 

Curb. 

The  hock  is  said  to  be  curl)ed  when  the  normal  appearance, 
viewed  from  the  side,  is  that  of  bulging  posteriorly  at  any  point 
between  the  summit  of  the  calcaneum  and  the  upper  third  of 
the  metatarsus.  Among  some  horsemen  a  hock  is  said  to  be 
"curby"  whenever  there  exists  an  enlargement  of  any  kind  on 
the  posterior  face  of  the  tarsus  whether  it  be  due  to  sprain, 
exostosis  or  proliferation  of  tissue  as  a  result  of  contusion. 

French  veterinarians  consider  under  the  title  of  "courbe,"  an 
exostosis  situated  on  the  mesial  side  of  the  distal  end  of  the  tibia. 
Cadiot  and  Almy  state  that  this  condition  (courbe)  is  of  rare 
occurrence.  Percivall  defines  curb  as  "a  prominence  upon  the 
back  of  the  hind  leg,  a  little  below  the  hock,  of  a  curvilinear 
shape,  running  in  a  direct  line  downwards  and  consisting  of 
infusion  into,  or  thickening  of,  the  sheath  of  the  flexor  tendons. ' ' 
Moller's  version  of  true  curb  is  a  thickening  of  the  plantar  liga- 
ment (calcaneocuboid  or  calcaneometatarsal).    Hughes  and  Mer- 


234  LAMENESS  OF  THE  HORSE 

illat  consider  curb  as  a  synovitis  having  for  its  seat  the  synovial 
bursa  which  is  situated  between  the  superficial  flexor  tendon 
(l)erforatus)  and  the  plantar  ligament. 

Occurrence. — Certain  predisposing  factors  seem  to  favor  the 
occurrence  of  curb.  A  malformation  of  tlie  inferior  part  of  the 
tai-sus  so  that  its  antero-posterior  diameter  is  considei'ably  less 
than  normal  is  a  contributing  cause.  Such  hocks  are  known  as 
"tied-in."  Another  fault  in  conformation  is  the  existence  of  a 
weak  hock  that  is  set  low  down  on  a  crooked  leg,  especially  when 
such  a  member  is  heavily  muscled  at  the  hip.  Given  such  con- 
formation in  an  excitable  horse,  and  curb  is  usually  produced  be- 
fore the  subject  is  old  enough  for  service.  It  is  certain  that  in 
cases  where  conformation  is  bad,  greater  strain  is  put  upon  the 
plantar  ligament.  This  structure  serves  to  bind  the  tibial  tarsal 
(calcis)  bone  to  the  metatarsus;  traction  exerted  upon  its  sum- 
mit by  the  tendo  Achillis  is  great  when  animals  run,  jump  or 
rear  and  also  at  heavy  pulling.  In  animals  having  curby  hocks, 
sprain  is  likely  to  result  and  curb  supervenes. 

Symptomatology. — The  characteristic  swellins:  which  marl^-s 
curl)  may  develop  quickly  and  lameness  occur  suddenly  or  the 
enlargement  comes  on  gradually  and  slowly,  causing  little  lame- 
ness. Lameness  is  not  proportionate  to  the  si7e  of  the  swelling 
and  in  all  cases  whether  subacute  or  chronic,  the  condition  im- 
proves with  rest,  but  lameness  is  again  manifested  upon  exertion. 
A  horse  which  "throws  a  curb"  will  go  lame  until  the  acute 
inflammatorv  condition  subsides  and  depending  upon  treatment 
received  and  conformation  of  the  hock,  this  requires  from  three 
days  to  two  or  three  weeks. 

The  character  of  the  swelling  varies;  in  some  cases  it  is  not 
larsre  but  rather  dense  and  lacking  in  evidence  of  heat  and 
hvperesthesia ;  in  other  eases  there  is  considerable  swellinsr,  which 
is  hot  and  doughy,  somewhat  painful  to  the  touch  but  not  neces- 
sarilv  productive  of  much  lameness.  Tn  anv  event,  whether  the 
swelling  or  enlargement  is  bier  or  little,  its  location  makes  it 
conspicuous  when  viewed  in  profile. 

Tn  most  cases  after  the  acute  inflammatory  period  has  passed, 
lameness  is  slight,  if  at  all  present,  and  in  time  no  interference 


(LAMENESS  IN  THE  HIND  LEG 


235 


with  the  subject's  usefulness  is  occasioned  because  of  the  curb, 
but  the  animals  often  remain  blemished — complete  resorption 
of  inflammatory  products  being-  unusual  wlien  much  disturbance 
has  existed. 

Treatment. — The  handling  of  curl)  during  the  acute  inflani- 
niMtdry  stage  is  along  the  same  lines  as  in  sprain — local  applica- 


4^ 


Fig.  55 — Spavin. 

tiotis  of  cold  and  heat.  Subjects  must  be  kept  quiet  until  all 
inflamnuition  has  subsided,  for  there  are  no  cases  wherein  a 
little  brisk  exercise  is  more  likely  to  cause  a  recurrence  of  lame- 
ness before  recovery  is  complete  than  in  curb.  Vesication  is  in 
order  in  a  week  or  ten  days  after  the  affection  has  set  in ;  in  old 
stubborn  cases  that  have  resisted  ordinary  treatment  for  a  few 
months,  the  use  of  the  actual  cautery  (line  firing)  is  to  be  recom- 
mended. 

Spavin.    (Bone  Spavin.) 
This  term  is  applied  to  an  affection  of  the  tarsus  which  is  usu- 
ally characterized  by  the  existence  of  an  exostosis  on  the  mesial 


236  LAMENESS  OF  THE  HORSE 

and  inferior  portion  of  the  liock.  There  is  also  included  under 
this  name,  articular  inflammation  wherein  no  external  evidence 
is  shown.  Spavin  lameness  has  long  been  recognized  and  much 
has  been  written  upon  this  subject.  Since  authorities  are  agreed 
that  most  cases  of  lameness  in  the  hind  leg  are  due  to  hock 
affection,  and  because  the  majority  of  cases  of  lameness  which 
have  the  tarsal  region  as  the  seat  of  trouble  are  instances  of  spa- 
vin lameness,  this  disease  merits  all  the  attention  it  has  received. 

Etiology  and  Occurrence. — Causes  may  well  be  classified  as 
predisposing  and  exciting,  for  there  are  many  etiologic  factors 
to  be  reckoned  with  in  spavin,  some  of  which  are  widely  different 
in  nature. 

Considered  as  predisposing  causes,  hereditary  influences  play 
an  important  role  and  may,  owing  to  faulty  conformation,  sub- 
ject an  animal  to  affections  of  this  kind  because  of  dispropor- 
tionate development  of  parts  (weak  and  small  joints  and  heavy 
muscular  hips)  ;  or  as  a  consequence  of  inherited  traits,  a  sub- 
ject may  manifest  susceptibility  to  degenerative  bone  changes 
which  are  signalized  by  the  formation  of  exostoses  of  different 
parts  on  one  or  more  of  the  legs.  Hereditary  predispositions 
make  for  the  presence  of  spavin  in  a  large  percentage  of  the 
progeny  of  sires  so  aft'ected.  This  fact  has  been  repeatedly 
demonstrated  in  this  country  as  well  as  elsewhere  according  to 
Quitman,  Dalrymple  and  Merillat.^  A  number  of  states  have 
passed  stallion  inspection  laws  stipulating  that  animals  having 
such  exostoses  as  spavin  and  ringbone  cannot  be  registered  ex- 
cept as  ''unsound." 

Asymmetrical  conformation,  particularly  where  the  hock  is 
obviously  small  and  weak  as  compared  with  other  parts  of  the 
leg,  constitutes  a  noteworthy  predisposing  cause. 

Peters'  theory  is  plausible  that  the  screw-like  joint  between 
the  tibia  and  the  tibial  tarsal  (astragulus)  bones  causes  these 
structures  to  functionate  in  a  manner  not  in  harmony  with  the 
provisions  allowed  by  the  collateral  ligaments  of  the  tarsus,  per- 


iDiscussions  on  paper  entitled  "The  Spavin  Group  of  Lamenesses,"  hy  W.  L. 
Williams,  Carl  W.  Fisher  and  D.  H.  Udall,  Proceedings  of  American  Veteri- 
nary Medical  Association,  1905. 


LAMENESS  IN  THE  HIND  LEG  237 

mitting  movement  only  in  a  direction  parallel  with  the  long  axis 
of  the  body. 

Because  of  the  quality  of  their  temperaments,  nervous  animals 
possessing  no  particular  congenital  structural  defects  of  the 
hock  and  having  no  history  of  spavined  progenitors,  are  subject 
to  spavin  when  kept  at  work  likely  to  produce  tarsal  sprain. 
Spavin  usually  develops  early  in  such  subjects  and  examples  of 
this  kind  may  be  frequently  observed  in  agricultural  sections 
of  the  country.  Where  spavin  develops  in  unshod  colts  at  three 
and  four  years  of  age,  shoeing  is  not  an  influencing  agency  when 
animals  are  not  worked  on  pavements. 

Exciting  causes  of  spavin  are  sprain  and  concussion.  Various 
hypotheses  are  recorded  as  to  how  sprains  are  influenced  and 
among  others  may  be  mentioned  that  of  McDonough^,  which  is 
that  the  foot  is  robbed  of  its  normal  manner  of  support  by  the 
ordinary  three-calked  shoe.  With  such  a  shoe,  little  support  is 
given  the  sides  of  the  foot;  hence,  undue  strain  is  put  upon  the 
collateral  ligaments  of  the  tarsus.  ^Moreover,  the  shoe  with  its 
calks  increases  the  length  of  the  leg  and  adds  to  the  leverage 
on  the  hock,  by  virtue  of  such  added  length.  This  makes  for 
greater  strain  upon  the  mesial  or  lateral  tarsal  ligaments  when- 
ever the  foot  bears  upon  a  sloping  ground  surface,  so  that  one 
side  (inner  or  outer)  is  higher  or  lower  than  the  other.  But 
according  to  McDonougli's  theory  (a  good  one  concerning  horses 
that  work  on  pavements),  the  chief  error  in  shoeing  lies  in  that 
the  foot  is  deprived  of  its  normal  base  or  support  on  the  sides 
— the  three-calked  shoe  being  an  unstable  support — and  that 
this  manner  of  shoeing  city  horses  working  on  pavements  is  an 
"inhumane"  practice,  a  "diabolical  method." 

Wliether  spavin  has  its  point  of  origin  within  the  articulation 
as  a  rarefying  ostitis  of  the  cancellated  structure  of  the  lower 
tarsal  bones  as  suggested  by  Eberlein ;  or,  as  Diekerhoff  asserts, 
that  the  cunean  bursa  may  be  the  initial  point  of  affection,  is 
unsettled ;  but  it  is  reasonable  to  consider  occult  spavin  as  having 
its  origin  within  the  articulation,  and  that  cases  readily  yielding 


i"Hock-Joint   Lameness,"   by   Dr.    James  McDonough,    Proceedings   of    the 
A.  V.  M.  A.,  1913,  page  545. 


238  LAMENESS  OF  THE  HORSE 

to  cunean  tenotomy  are  primarily  due  to  affection  of  the  cunean 
bursa. 

Symptomatology. — Where  a  visible  exostosis  exists,  the  pres- 
ence of  spavin  is  easily  detected,  yet  exostoses  that  extend  over 
large  areas  may  constitute  cause  for  serious  trouble  and  still  be 
difficult  of  detection.  By  observing  the  internal  surface  of  the 
hock  from  various  suitable  angles,  such  as  from  between  the 
forelegs  or  directly  behind  the  subject,  one  may  note  the  pres- 
ence of  any  ordinary  exostosis. 

The  position  assumed  by  the  spavined  horse  is  often  charac- 
teristic. More  or  less  knuckling  is  usually  present  (Liautard, 
McDonald) .  There  is  abduction  of  the  stifle  in  some  cases,  or  the 
toe  may  be  worn  in  unshod  horses  so  that  it  presents  a  straight 
line  at  the  surface.  This  is  manifested  to  a  great  degree  in  some 
animals  and  in  others  the  foot  is  not  dragged  and  there  is  no 
wearing  of  the  hoof  at  the  toe. 

Spavin  lameness  is  so  distinctive  that  one  trained  and  experi- 
enced in  the  examination  of  horses  that  are  spavined,  should 
correctly  diagnose  the  condition  in  practically  every  instance 
without  recourse  to  other  means  than  noting  the  peculiar  char- 
acter of  the  gait  of  the  subject.  Lameness  develops  gradually 
in  the  majority  of  instances,  and  an  important  feature  in  spavin 
lameness  is  that  it  disappears  after  the  subject  has  gone  a  little 
way,  to  return  again  as  soon  as  the  animal  has  rested  for  a 
variable  length  of  time— from  a  half  hour  to  several  hours.  This 
"warming  out"  is  marked  during  the  incipient  stage,  but  less 
pronounced  in  most  chronic  cases.  A  complete  disappearance 
of  lameness  is  observed  in  some  instances,  while  in  others  only 
partial  subsidence  is  evident.  Because  of  the  fact  that  pain  is 
occasioned  both  during  weight  bearing  and  while  the  leg  is  being 
flexed  and  advanced,  there  is  manifested  the  characteristic  mixed 
lameness  and  exaggerated  hip  action  which  typifies  spavin.  By 
throwing  the  hips  upward  with  the  sound  member  it  is  possible 
to  advance  the  affected  leg  with  less  flexion,  hence  less  pain  is 
experienced  in  this  manner  of  locomotion.  When  made  to  step 
aside  in  the  stall,  a  spavined  horse  will  flex  the  affected  member 
abruptly  and  when  weight  is  taken  on  the  diseased  leg,  symp- 


(LAMENESS  IN  THE  HIND  LEG  239 

toms  are  evinced  of  pain,  and  weight  is  immediately  shifted  to 
the  sound  limb.  This  is  marked  during  the  incipient  stages  of 
spavin.  Lameness  usually  precedes  the  formation  of  exostosis, 
though  cases  are  observed  wherein  an  exostosis  is  present  and 
no  lameness  is  manifested  and  no  history  of  the  previous  exist- 
ence of  lameness  is  available. 

The  "spavin  test"  is  of  value  as  a  diagnostic  measure  when 
it  is  employed  with  other  means  of  examination,  though  reaction 
to  this  test  is  seen  in  some  cases  in  old  "crampy"  horses  that 
have  experienced  hard  service.  The  test  consists  in  flexing  the 
affected  leg  (elevating  the  foot  from  the  ground  twelve  to 
twenty- four  inches)  and  holding  the  member  in  this  position  for 
a  minute,  whereupon  the  animal  is  made  to  step  away  immedi- 
ately at  a  trot.  During  the  first  few  steps  taken  directly  there- 
after, the  subject  shows  pronounced  lameness  and  this  constitutes 
a  reaction  to  the  spavin  test. 

Where  no  exostosis  is  present  it  becomes  necessary  to  exclude 
other  causes  for  lameness  but  the  characteristic  spavin-lameness 
is  to  be  relied  upon  to  a  greater  extent  in  such  cases  than  are 
other  means  of  examination.  Such  cases  are  known  as  occult 
spavin  and  may  be  present  for  months  before  any  external 
changes  in  structure  are  observable.  In  some  instances  no  ex- 
toses  form  even  during  the  course  of  years.  The  spavin  test  is 
of  aid  in  establishing  a  diagnosis  here  but  the  marked  "warm- 
ing out"  peculiar  to  spavin  is  not  so  pronounced  in  such  cases. 

Prognosis. — An  animal  having  hereditary  predisposition  to 
spavin  is  not  likely  to  recover  completely  whether  this  predis- 
position be  due  to  faulty  conformation  or  susceptibility  to  bone 
changes.  In  predicting  the  outcome,  the  temperament  of  the 
subject  is  to  be  taken  into  account,  as  well  as  the  character  of 
service  the  animal  is  expected  to  perform.  And  finally,  a  very 
important  feature  to  be  noted,  is  the  location  of  the  exostosis. 
If  situated  rather  high  and  extending  anterior  to  the  hock,  there 
is  less  likelihood  of  recovery  resulting  than  where  an  exostosis 
is  confined  to  the  lower  row  of  tarsal  bones.  When  situated 
anterior  to  the  tarsus  a  large  exostosis  may  by  mechanical  inter- 
ference to  function,  cause  lameness  when  all  other  causes  are 


240  LAMENESS   OF  THE  HORSE 

absent.  In  making  examinations  one  must  not  be  deceived 
by  the  inconspicuous  and  seemingly  insignificant  exostosis  which 
has  a  broad  base.  In  some  eases  of  this  kind,  dealers  style  the 
condition  as  "rough  in  the  hock"  when  as  a  matter  of  fact,  in 
some  instances,  incurable  spavin  lameness  develops. 

Treatment. — Many  incipient  cases  of  spavin  yield  to  vesica- 
tion and  a  protracted  period  of  rest.  Results  depend  primarily, 
upon  the  nature  of  the  affection.  However,  in  every  instance 
if  there  is  involvement  of  the  tibial  tarsal  (astragalus)  bone, 
complete  recovery  is  highly  improbable.  When  the  disease  is 
confined  to  the  lower  tarsal  bones,  lameness  subsides  as  soon  as 
the  degenerative  changes  are  checked  and  ankylosis  occurs. 

The  use  of  the  actual  cautery  when  properly  employed  con- 
stitutes an  excellent  method  of  treatment.  The  "auto-cautery" 
when  equipped  with  a  point  of  about  one-eighth  of  an  inch  in 
diameter  and  about  three-fourths  of  an  inch  in  length  is  well 
suited  for  this  particular  operation.  Before  deciding  to  cauter- 
ize, it  is  necessary  to  ascertain  the  extent  of  area  affected.  The 
nearness  of  the  exostosis  to  the  tibiotarsal  articulation  can  be 
definitely  determined  by  palpation.  The  hair  over  the  entire 
surgical  field  is  clipped  and  the  cautery  at  white  heat  is  pushed 
through  the  overlying  soft  tissues  and  into  the  central  part  of 
the  exostosis.  Care  is  taken  to  keep  the  cautery-point  away  from 
the  articular  margin  of  the  tibial  tarsal  bone  about  three-fourths 
of  an  inch.  No  danger  will  result  from  cauterizing  to  a  depth 
of  three-fourths  of  an  inch  in  the  average  case.  Two  or  three 
(and  not  more)  centrally  located  points  for  penetration  with  the 
cautery  are  sufficient.  Experience  has  shown  that  several  (five 
or  six  or  more)  punctures  are  not  productive  of  good  results. 
When  considerable  cicatricial  tissue  is  present,  due  to  the  action 
of  depilating  vesicants  or  other  chemicals,  sloughing  of  tissue 
is  very  apt  to  follow  deep  cauterization,  if  one  is  not  careful  to 
keep  the  punctures  at  least  one-half  inch  apart  when  three  are 
made.  It  is  best,  in  such  cases,  to  make  but  two  deep  penetra- 
tions with  the  cautery  but  additional  superficial  punctures  may 
be  made  if  kept  about  three-fourths  of  an  inch  distant  and  not 
nearer  than  this  to  one  another.  Sloughing  of  tissue  is  not  nec- 
essarily productive  of  bad  results  but  there  is  occasioned  an  open 


LAMENESS  IN  THE  HIND  LEG  241 

wound  wliieli  usually  becomes  infected  and  necrosis  of  tissue  may 
extend  into  the  articulation.  No  benefit  results  from  sloughing 
and  it  should  be  avoided.  In  small  horses,  one  deep  point  of 
cauterization  is  sufficient  if  the  osseous  tissues  are  penetrated  to 
a  proper  depth  so  that  an  active  inflammation  is  induced.  The 
cautery  may,  if  necessary,  be  reintroduced  several  times.  When 
the  field  of  operation  has  been  properly  prepared  and  it  is 
thought  advisable  (as  where  subjects  are  kept  in  the  hospital  for 
a  time),  the  hock  may  be  covered  with  cotton  and  bandaged  and 
no  chance  for  infection  w^ill  occur. 

After  cauterization  the  subject  should  be  kept  quiet  in  a  com- 
fortable stall  for  three  wrecks;  thereafter,  if  the  animal  is  not 
too  playful,  the  run  of  a  paddock  may  be  allowed  for  about  ten 
days  and  a  protracted  rest  of  a  month  or  more  at  pasture  is 
best.  It  is  unwise  in  the  average  case  to  put  an  animal  in 
service  earlier  than  two  months  after  having  been  "fired." 

Where  cases  progress  favorably,  lameness  subsides  in  about 
three  weeks  after  cauterization  and  little  if  any  recurrence  of 
the  impediment  is  manifested  thereafter.  However,  because  of 
violent  exercise  taken  in  some  instances  when  subjects  are  put 
out  after  being  confined  in  the  stall,  a  return  of  lameness  occurs 
and  it  may  remain  for  several  days  or  in  some  cases  become  per- 
manent. No  good  comes  from  the  use  of  blistering  ointments 
immediately  after  cauterization.  The  actual  cautery  is  a  means 
of  producing  all  necessary  inflammation  and  it  should  be  so  em- 
ployed that  sufficient  reactionary  inflammation  succeeds  such 
firing.  The  use  of  a  vesicating  ointment  subsequent  to  cauteriza- 
tion invites  infection  because  of  the  dust  that  is  retained  in  con- 
tact with  the  w^ound.  The  employment  of  irritating  chemicals 
in  a  liquid  form  following  firing  is  needless  and  cruel. 

In  many  instances  lameness  is  not  relieved  and  subjects  show 
no  improvement  at  the  end  of  six  weeks  time  and  it  then  becomes 
a  question  of  whether  or  not  recovery  is  to  be  expected  even  with 
continued  rest  and  treatment.  As  a  rule,  such  cases  are  unfavor- 
able. In  one  instance  the  author  employed  the  actual  cautery 
three  times  during  the  course  of  six  months  and  lameness  gradu- 
ally diminished  for  a  year.  In  this  case  the  spavin  was  of  nearly 
one  year's  standing  when  treatment  was  instituted.     The  sub- 


242  LAMENESS  OB"  THE  HORSE 

jeet  was  a  nervous  and  restless  but  well-formed  seven-year-old 
gelding.  Recovery  was  not  complete;  recurrent  intervals  of 
lameness  marked  this  case,  but  the  horse  limped  so  slightly  that 
the  average  observer  could  not  detect  its  existence  after  the  ani- 
mal had  been  driven  a  little  way. 

Cunean  tenotomy  has  been  advocated  and  practiced  by  Abild- 
gaard,  Lafosse,  Peters,  Herring,  Zuill  and  others  and  good  re- 
sults have  followed  in  many  cases  so  treated. 

Considering  results,  the  employment  of  chemicals  of  various 
kinds  for  the  purpose  of  relieving  spavin  lameness  does  not  com- 
pare favorably  with  firing.  IMoreover,  so  many  animals  have 
been  tortured  and  needlessly  blemished  in  the  attempted  cure 
of  spavin  that  agents  which  are  not  of  known  value,  the  use  of 
which  are  likely  to  result  in  extensive  injury  to  the  tissues,  are 
only  to  be  condemned. 

When  spavin  is  bilateral  and  lameness  is  likewise  affecting 
both  members,  prognosis  is  at  once  unfavorable.  Such  cases  are 
often  benefited  by  cauterization  but  only  one  leg  at  a  time  should 
be  treated. 

Bossi's  double  tarsal  neurectomy  (division  of  the  anterior  and 
posterior  tibial  nerves)  has  undoubtedly  been  of  decided  benefit 
in  many  cases,  but  is  not  at  present  a  popular  method  of  treat- 
ment in  this  country.  This  operation  has  its  indications,  how- 
ever, and  may  be  recommended  in  chronic  lameness  where  no 
extensive  exostosis  exists  which  may  mechanically  interfere  with 
function. 

Distension  of  the  Tarsal  Joint  Capsule.      (Bog  Spavin.) 

Distension  of  the  capsular  ligament  of  the  tibial  tarsal  (tibio- 
astragular)  joint  with  synovia  is  commonly  known  as  bog  spavin. 
This  condition  is  separate  and  distinct  fiom  that  of  distension 
of  the  sheath  of  the  deep  flexor  tendon  (j^erforans)  though  not 
infrequently  the  two  affections  coexist. 

Etiolog'y  and  Occurrence. — Following  strains  from  work  in 
the  harness  or  under  the  saddle,  horses  develop  an  acute  syno- 
vitis of  the  hock  joint,  which  often  results  in  chronic  synovial 
distension.     Debilitating  diseases  favor  the  production  of  this 


OLAMENESS  IN  THE  HIND  LEG 


243 


affection  in  some  animals.  It  is  also  frequently  observed  in 
young  horses  and  in  draught  colts  of  twelve  to  eighteen  months 
of  age.     This  condition  occurs  while  the  subjects  are  at  pasture 


Fig.  56 — Bog  spavin.  Showing  point  of  view  which  may  be  most  advan- 
tageously taken  by  the  diagnostician  in  examining  for  distension  of  the 
capsular  ligament  of  the  tarsal  joint. 

and  often  spontaneous  recovery  results  by  the  time  the  animals 
are  two  years  of  age. 

Symptomatology. — Bog  spavin  is  recognized  by  the  dis- 
tended condition  of  the  joint  capsule  which  is  prominent  just 
below  the  internal  tibial  malleolus  and  this  affection  is  character- 


244  LAMENESS  OF  THE  HORSE 

ized  by  a  fluctuatiug  swelling  which  varies  considerably  in  size 
in  different  subjects.  Except  in  cases  of  acute  synovitis,  lame- 
ness is  not  present  and  in  chronic  distension  of  the  capsule  of 
the  tarsal  joint,  no  interference  with  the  subject's  usefulness 
occurs.  In  the  majority  of  instances,  the  disfigurement  which 
attends  bog  spavin  is  the  jDrincipal  objectionable  feature.  The 
condition  is  bilateral  in  many  instances,  and  in  such  cases  the 
subjects  have  a  predisposition  to  this  condition  or  it  follows 
attacks  of  strangles  or  other  debilitating  ailments.  Because  of 
a  rapid  and  unusual  growth,  bilateral  affections  are  of  frequent 
occurrence  in  some  animals. 

Treatment. — The  most  practical  method  of  handling  bog 
spavin  consists  in  aspiration  of  synovia  and  injection  of  tincture 
of  iodin.  Discretion  should  be  employed  in  selecting  subjects 
for  treatment,  regardless  of  the  manner  in  which  such  cases  are 
to  be  handled.  Where  there  exists  chronic  distension  of  the 
joint  capsule  of  several  years'  standing  in  old  or  weak  subjects, 
needless  to  say,  recovery  is  not  likely  to  result.  When  animals 
are  vigorous  and  two  or  three  months'  time  is  available,  treat- 
ment may  be  begun  with  reasonable  hope  for  success. 

The  average  subject  is  handled  standing  and  can  be  restrained 
with  a  twitch,  sideline  and  hood.  Aspirating  needles  and  all 
necessary  equipment  must  be  in  readiness  (sterile  and  wrapped 
in  aseptic  cotton  or  gauze)  so  that  no  delay  will  occur  from  this 
cause  when  the  operation  has  been  started.  The  central  or  most 
prominent  part  of  the  distended  portion  of  the  capsule  is  chosen 
for  perforation  and  an  area  of  an  inch  and  a  half  in  diameter 
is  shaved.  The  skin  is  cleansed  and  then  painted  with  tincture 
of  iodin.  The  sterile  aspirating  needle  is  pushed  through  the 
tissues  and  into  the  capsule  with  a  sudden  thrust.  With  a  large 
and  sharp  needle  (fourteen  gauge),  synovia  can  be  drawn  from 
the  cavity  in  most  instances  and  the  subject  usually  ott'ers  no 
resistance.  By  compressing  the  distended  capsule  and  surround- 
ing structures  with  the  fingers,  considerable  synovia  may  be 
evacuated.  In  singular  instances,  no  synovia  is  to  be  aspirated 
with  the  needle,  and  in  such  cases  the  amount  of  iodin  injected 
needs  be  increased,  possibly  twenty-five  per  cent.,  as  experience 


[LAMENESS  IN  THE  HIND  LEG  245 

will  indicate.  From  two  to  five  cubic  centimeters  of  U.  S.  P. 
tincture  of  iodin  is  injected  through  the  aspirating  needle  into 
the  synovial  cavity  of  the  joint,  and  the  exterior  of  the  parts  are 
vigorously  massaged  immediately  after  injection  to  stimulate 
distribution  of  the  iodin  throughout  the  synovial  cavity.  "Where 
a  bilateral  affection  exists,  two  or  three  weeks'  time  should  inter- 
vene between  the  treatments  of  each  leg.  A  sterile  metal  syringe 
equipped  with  a  slip  joint  for  the  needle  is  well  adapted  to  this 
operation.  Lubrication  of  the  plunger  with  heavy  sterile  vaseline 
or  glycerin  will  prevent  the  syringe  from  being  ruined  by  the 
iodin. 

Following  the  injection,  the  subject  is  kept  in  a  stall  or  in 
a  suitable  paddock,  so  that  conditions  may  be  observed  for  four 
or  five  days.  The  object  sought  by  the  introduction  of  iodin 
is  not  only  for  a  local  effect  upon  the  synovial  membranes  in 
checking  secretions,  but  the  production  of  an  active  inflamma- 
tion and  great  swelling,  which  will  remain  from  four  weeks 
to  three  months  subsequent  to  the  injection.  This  periarticular 
swelling  should  produce  and  maintain  a  constant  pressure  over 
the  entire  affected  parts  for  a  sufficient  length  of  time  until  nor- 
mal tone  is  re-established. 

In  some  cases,  swelling  does  not  develop  as  the  result  of  a 
single  injection  of  iodin.  When  marked  swelling  has  not  taken 
place  within  five  days,  none  will  occur  and  a  repetition  of  the 
injection  may  be  made  within  ten  days  after  the  first  treatment 
has  been  given.  One  may  safely  increase  the  amount  of  iodin 
at  the  second  injection  in  such  cases  by  one-fourth  to  one-third. 
In  Europe  this  method  of  treating  bog  spavin  has  been  em- 
ployed by  Leblanc,  Abadie,  Dupont  and  others  according  to 
Cadiot;  but  Bouley,  Key,  Lafosse  and  Varrier  used  it  with  bad 
results.  Where  a  perfect  technic  is  executed  (and  no  other  is 
excusable  in  this  operation),  no  infection  will  occur  if  a  reason- 
able amount  of  iodin  is  injected.  The  dilution  of  iodin  with  an 
equal  amount  of  alcohol  has  been  practised  by  the  author  in 
many  cases,  but  later  this  was  found  unnecessary. 

Other  methods  of  treatment  have  been  used  with  success.    Per- 
haps the  most  heroic  consists  in  opening  the  joint  capsule  with  a 


246  LAMENESS  OF  THE  HORSE 

bistoury  or  with  the  actual  cautery.  Such  practice  is  too  hazard- 
ous for  general  use  and  is  not  to  be  recommended,  although  good 
results  should  follow  the  employment  of  such  methods  if  infec- 
tious arthritis  does  not  occur. 

Line  firing  over  the  distended  capsule  is  a  practical  method 
of  treatment.  This  is  attended  with  good  results  in  young  ani- 
mals in  many  cases,  but  considerable  blemish  is  caused  when 
sufficient  irritation  is  produced  to  stimulate  resolution. 

Vesication  also  is  successfully  employed  in  some  instances. 
However,  only  eases  of  recent  origin  in  young  animals — colts  of 
two  years  or  younger — yield  to  blistering,  and  in  some  affected 
colts  no  doubt  recovery  would  have  been  spontaneous  had  no 
treatment  been  instituted. 

Ligation  of  the  saphenous  vein  at  two  points,  one  above  and 
the  other  below  the  distended  ligamentous  capsule,  is  an  old 
operation,  which  has  undoubtedly  given  good  results  in  some 
cases,  although  it  does  not  seem  to  be  a  rational  procedure. 

After-Care. — After  swelling  has  fully  developed — which  oc- 
curs witliin  a  week — the  subject  is  turned  to  pasture  and  no  at- 
tention is  necessary  thereafter.  A  gradual  subsidence  of  the 
swelling  occurs  and  in  the  average  instance,  this  completely  re- 
solves within  six  or  eight  weeks. 

Complete  recovery  succeeds  the  aspiration-and-injection-treat- 
ment  in  about  seventy-five  per  cent  of  cases  as  the  result  of  one 
operation,  and  subjects  may  be  gradually  and  carefully  returned 
to  work  in  about  sixty  days  after  treatment  has  been  given. 

Distension  of  the  Tarsal  Sheath  of  the  Deep  Digital  Flexor. 
(  Thoroughpin. ) 

The  terms  ''thoroughpin"  or  "throughpin"  are  translations 
from  the  French  vessignon  clieviUe  and  have  the  same  signifi- 
cance. They  are  so  named  because  of  the  diametrically  opposed 
distensions  of  the  sheath  of  the  deep  flexor  tendon  in  such  man- 
ner that  the  distensions  appear  to  be  due  to  a  supporting  peg. 

Anatomy. — The  theca  tlirough  whieli  the  deep  digital  flexor 
(perforans)  plays  in  the  tarsal  region,  begins  about  three  inches 


LAMENESS  IN  THE  HIND  LEG  247 

above  the  inner  tibial  malleolus  and  extends  about  one-fourth 
of  the  way  down  the  metatarsus.  The  posterior  part  of  the 
capsular  ligament  of  the  hock  joint  is  very  thick  in  its  most 
dependent  portions  and  is  in  part  cartilaginous,  forming  a  suit- 
able groove  for  the  passage  of  the  deep  flexor  tendon. 

Etiology  and  Occurrence. — Strains  and  sequellae  to  debili- 
tating: diseases  constitute  the  usual  causes  of  this  affection.    As 


Lz^y 


Fig.  57— Thoroughpin.  Showing  distension  of  tlie  sheath  of  the  deep  flexor 
tendon  as  it  protrudes  antero-externally  to  the  fibular  tarsal  bone  (cal- 
caneum). 

a  result  of  acute  synovitis  a  chronic  synovial  distension  of  the 
tarsal  sheath  occurs.  Bog  spavin  is  often  present  in  case  of 
thoroughpin  but  the  two  conditions  are  separate  and  distinct 
excepting  in  that  both  may  occur  simultaneously  and  as  the 
result  of  the  same  cause.  Some  animals  are  undoubtedly  pre- 
disposed to  disease  of  synovial  structures.  The  average  horse 
that  has  been  subjected  to  hard  service  on  pavements  or  hard 
roads  at  fast  work  suffers  synovial  distension  of  bursae,  thecae 
or  of  joint  capsules.     Some  of  the  well  bred  types  such  as  the 


248  LAMENESS  OF  THE  HORSE 

thoroughbred  liorses  may  be  subjected  to  years  of  hard  service 
and  still  remain  "clean  limbed"  and  free  from  all  blemishes. 
Thus  it  seems  that  subjects  of  rather  faulty  conformation,  ani- 
mals having  lymphatic  temperaments  and  the  coarse-bred  types, 
are  prone  to  synovial  disturbances  such  as  thoroughpin,  bog 
spavin,  etc.,  sometimes  having  both  legs  affected. 

Symptomatology. — Thoroughpin  is  characterized  by  a   dis- 
tended condition  of  the  tarsal  sheath  which  is  manifested  by 


Fig.  58 — Fibrosity  of   larsus  as  a   complication  in  clironic  thoroughpin. 

protrusions  anterior  to  the  tendo  Achillis.  However,  where  but 
moderate  distension  of  the  sheath  exists,  there  is  little,  if  any, 
bulging  on  the  mesial  side  of  the  hock  and  but  a  small  hem- 
ispherical enlargement  is  presented  on  the  outer  side  of  the 
tarsus,  anterior  to  the  summit  of  the  os  calcis.  In  some  instances 
the  protruding  parts  assume  large  proportions,  but  always,  be- 
cause of  the  relationship  between  the  fibular  tarsal  bone  (cal- 
caneum)  and  the  tendon  sheath,  the  larger  protrusion  is  situated 
mesially. 


LAMENESS  IN  THE  HIND  LEG 


249 


During  the  acute  inflammatory  stage  there  is  marked  lameness 
present  but  this  soon  subsides  when  local  antiphlogistic  agents 
are  applied  to  the  parts.  In  fact,  spontaneous  relief  from  lame- 
ness usually  results  in  the  course  of  ten  days'  time  following  the 
appearance  of  thoroughpin.     No  lameness  marks  the  advent  of 


Fig-.   59 — Another  view   of   same   case  as  illustrated  in   Fig.   58. 

this  affection  when  it  develops  as  the  result  of  continuous  strain 
and  concussion  occasioned  by  hard  service,  and  local  changes 
tend  to  remain  in  status  quo. 

Treatment. — Rest  and  the  local  application  of  heat  or  cold 
will  suffice  to  promote  resolution  of  acute  inflammation  and  lame- 
ness when  present  will  subside  within  two  weeks.  In  chronic 
affections,  however,  the  matter  and  manner  of  effecting  a  cor- 


250  LAMENESS  OF  THE  HORSE 

rection  of  the  condition — distended  tarsal  sheath — merit  careful 
consideration.  AVhile  drainage  of  distended  thecae  and  bursae 
by  means  of  openings  made  with  hot  irons  was  practiced  by  the 
Arabs,  centuries  ago,  and  good  results  have  attended  such  heroic 
corrective  measures,  nevertheless  the  occasional  serious  complica- 
tions which  result  from  infection  likely  to  be  introduced  in  fol- 
lowing such  procedures,  cause  the  prudent  and  skilful  practi- 
tioner to  employ  safer  methods  of  treatment. 

The  application  of  blistering  agents  is  of  no  value  in  stimu- 
lating resorption  of  an  excessive  amount  of  synovia  in  chronic 
cases  and  the  actual  cautery  when  employed  without  perfora- 
tion of  the  synovial  structure,  is  of  little  benefit.  Trusses  or 
mechanical  appliances  for  the  purpose  of  maintaining  pressure 
upon  the  distended  parts  are  of  no  practical  value  because 
of  the  great  difficulty  of  keeping  such  contrivances  in  position. 
They  usually  cause  so  much  discomfort  to  the  subject  that  they 
are  not  tolerated. 

A  very  practical  and  fairly  successful  method  of  treatment 
consists  in  the  aspiration  of  a  quantity  of  synovia  and  injecting 
tincture  of  iodin.  Cadiot  recommends  the  drainage  of  synovia 
with  a  suitable  trocar  and  cannula  and  injecting  a  mixture 
consisting  of  tincture  of  iodin,  one  part,  to  two  parts  of  sterile 
water,  to  which  is  added  a  small  quantity  of  potassium  iodid. 
The  latter  agent  is  added  to  prevent  precipitation  of  the  iodin. 
This  authority  (Cadiot)  further  advocates  the  removal  of  prac- 
tically all  of  the  synovia  that  will  run  out  through  the  cannula 
and  the  immediate  introduction  of  as  much  as  one  hundred  cubic 
centimeters  of  the  above  mentioned  iodin  solution.  This  solu- 
tion is  allowed  to  remain  in  the  synovial  cavity  a  few  minutes 
and  by  compressing  the  tissues  surrounding  the  tendon  sheath, 
the  evacuation  of  as  much  of  the  contents  of  the  synovial  cavity 
as  is  practicable,  is  effected.  Subsequently  the  subject  is  al- 
lowed absolute  rest  and  more  or  less  inflammatory  reaction  fol- 
lows. In  some  cases  there  occur  marked  lameness  and  some 
febrile  disturbance,  but  where  a  good  technic  is  carried  out, 
no  bad  results  follow.  At  the  end  of  four  weeks'  time,  horees 
so  treated  may  be  returned  to  service,  but  the  full  beneficial 


[LAMENESS  IN  THE  HIND  LEG  251 

effect  of  such  treatment  is  not  experienced  until  several  months' 
time  have  elapsed. 

Where  good  facilities  for  executing  a  careful  technic  in  every 
detail  are  at  hand,  incision  of  the  tarsal  sheath,  evacuation  of 
its  contents  and  uniting  its  walls  again  by  means  of  sutures 
and  providing  for  drainage  with  a  suitable  drainage  tube,  may 
be  practiced.  This  manner  of  treatment  has  been  satisfactory 
in  the  hands  of  a  number  of  surgeons. 

Capped  Hock. 

Enlargements  which  occur  upon  the  summit  of  the  os  calcis, 
whether  hypertrophy  of  the  skin  and  rmbcuticular  fascia,  the 
result  of  injury  or  repeated  vesication,  distension  of  the  sub- 
cutaneous bursa  or  injury  to  the  superficial  flexor  tendon  (per- 
foratus)  or  its  sheath,  are  generally  known  as  capped  hock. 
However,  the  term  should  be  restricted  to  use  in  reference  to 
distensions  of  synovial  structures  of  that  region. 

Etiology  and  Occurrence. — Usually  there  occurs  a  hygrom- 
atous  involvement  of  the  subcutaneous  bursa  due  to  contusion. 
As  in  bog  spavin,  following  certain  infectious  diseases  (influ- 
enza, purpura  hemorrhagica,  etc.)  there  remains  a  distended  con- 
dition of  the  subcutaneous  bursa,  after  swelling  of  the  member 
has  subsided.  In  feeding  pens  where  numbers  of  young  mules 
are  kept  in  crowded  quarters  many  cases  may  be  observed.  In 
some  instances  where  violent  contusions  result  from  kicking 
cross-bars  of  wagon  shafts  (by  nymphomaniacs  or  in  habitual 
kickers  where  there  is  opportunity  for  doing  such  injury)  the 
superficial  flexor  tendon  and  its  synovial  apparatus  are  injured 
and  a  more  serious  condition  may  result. 

Symptomatolog'y. — In  acute  and  extensive  inflammation  of 
the  pai'ts,  lameness  is  present,  but  in  the  average  case  no  in- 
convenience to  the  subject  results.  The  prominent  site  of  the 
affection  is  cause  for  an  unsightly  blemish.  This  is  undesirable, 
particularly  in  light-harness  or  saddle  horses.  These  affections 
are  characterized  by  a  fluctuating  mass  which  has  a  thin  wall 
and  in  all  cases  of  long  standing  the  condition  is  painless. 


252  LAMENESS  OP  THE  HORSE 

By  careful  palpation  one  may  readily  distinguish  between  a 
hygromatous  condition  of  the  superficial  bursa  and  involvement 
of  the  underlying  structures.  Affection  of  the  expanded  portion 
of  the  flexor  tendon  and  contiguous  structures  makes  for  an 
organized  mass  of  tissue  which  is  somewhat  dense  and  in  some 
instances  painful  to  the  subject  when  manipulated.    This  is  par- 


Fig.   60 — "Capped  hock."     Distension  of  the  bursa  over  the  summit  of  tlie 
OS  calcis. 

ticularly  noticeable  in  eases  where  the  parts  are  regularly  and 
repeatedly  injured  as  in  habitual  kickers. 

Treatment. — In  acute  inflammation,  antiphlogistic  applica- 
tions arc  indicated  and  the  subject  must  be  kept  quiet.  The 
matter  of  bandaging  the  hock  is  a  difflcult  problem  in  some  cases 
and  needs  be  done  with  care.  As  has  been  previously  stated  in 
this  volume,  the  tarsus  needs  to  be  well  padded  with  cotton  be- 
fore the  bandages  are  applied  and  only  a  moderate  degree  of 
tension  is  employed  in  applying  the  bandages  lest  anemic-necrosis 
result  from  pressure.  In  distension  of  the .  superficial  bursa, 
after  clipping  the  hair  over  a  liberal  area  and  preparing  the  skin 


LAMENESS  IN  THE  HIND  LEG  253 

by  thoroughly  cleansing  and  painting  with  tincture  of  iodin,  the 
capsule  is  incised  with  a  bistoury.  An  incision  about  an  inch 
in  length,  situated  low  enough  to  provide  drainage,  is  made 
through  the  tissues  and  the  contents  are  evacuated.  Tincture 
of  iodin  is  injected  into  the  cavity  and  the  parts  are  covered 
with  cotton  and  bandaged.  No  after-care  is  necessary  except  to 
retain  the  dressing  in  position,  which  is  not  difficult  in  the 
average  case  if  the  subject  is  kept  tied.  If  much  resistance  is 
exhibited,  such  as  extreme  flexion  of  the  bandaged  hock,  the 
animal  may  be  put  in  a  sling  and  little  if  any  objection  to  the 
bandage  will  be  offered  thereafter.  The  wound  may  be  dressed 
at  the  end  of  forty-eight  hours  and  no  redressing  will  be  neces- 
sary in  the  average  instance  if  infection  is  not  present.  But 
slight  local  disturbance  and  little  distress  to  the  subject  result 
in  cases  so  treated  even  when  infection  occurs,  but  a  good  technic 
is  possible  of  execution  in  most  instances  and  no  infection  should 
take  place. 

The  surgical  wound  heals  in  two  or  three  weeks  and  inflamma- 
tion gradually  subsides.  Bandages  are  retained  one  or  two 
weeks,  as  the  case  may  require,  and  subsequently  a  good  wound 
lotion  may  be  employed  several  times  daily.  A  good  lotion  for 
such  cases  as  well  as  in  many  others  has  long  been  employed 
with  success  by  Dr.  A.  Trickett  of  Kansas  City.  It  consists  of 
approximately  equal  parts  of  glycerin,  alcohol  and  distilled  ex- 
tract of  witch  hazel,  to  which  is  added  liquor  cresolis  compositus, 
two  percent,  and  coloring  matter  q.  s. 

Complete  resolution  does  not  occur  in  the  average  case.  There 
remains  some  hyperplastic  tissue  and  even  where  the  enlarge- 
ment is  slight,  the  prominent  situation  of  the  affection  precludes 
its  being  unnoticed. 

In  disease  of  the  flexor  tendon  and  its  bursa  where  contiguous 
inflammation  of  tissue  is  present,  the  parts  are  blistered  or  fired. 
Line  firing  is  beneficial  in  such  instances  but  in  all  cases  the 
cause  is  to  be  removed  if  possible. 

Rupture  and  Division  of  the  Long  Digital  Extensor 
(Extensor  Pedis). 

Etiology  and  Occurrence. — Because  of  the  fact  that  the  long 


254  LAMENESS  OF  THE  HORSE 

digital  extensor  is  the  only  extensor  of  the  phalanges  of  the 
pelvic  limb,  its  rupture  or  division  coiistitutes  a  troublesome 
condition,  which  in  some  eases  does  not  readily  respond  to  treat- 
ment. 

Rupture  of  this  tendon  may  occur  during  work  on  rough  and 
uneven  roads,  particularly  in  range  horses  that  are  ridden  over 
ground  that  is  burrowed  by  gophers  or  prairie  dogs;  in  such 
cases,  horses  are  apt  to  suddenly  and  violently  turn  the  foot 
in  position  of  volar  flexion,  thereby  causing  undue  strain  to  the 
digital  extensor  and  its  rupture  sometimes  follows.  In  foals 
of  one  or  two  days  of  age,  this  tendon  is  sometimes  found  parted 
or  ruptured  and  the  condition  may  be  bilateral. 

As  the  result  of  accidents,  the  digital  extensor  may  be  divided 
and  when  the  wound  becomes  contaminated,  as  it  does  because 
of  the  marked  volar  flexion  (knuckling)  which  occurs  during  the 
course  of  this  affection,  regeneration  of  tissue  is  checked  and  re- 
covery is  tardy. 

Symptomatology. — There  is  no  interference  with  ability  to 
sustain  weight  in  such  cases,  when  the  foot  is  placed  in  normal 
position;  but  immediately  upon  attempting  to  walk,  the  toe  is 
dragged,  and  if  weight  is  borne  with  the  affected  member,  it 
comes  upon  the  anterior  face  of  the  fetlock.  The  flexors  are 
not  antagonized  and  if  there  be  an  open  wound  the  parts  soon 
become  contaminated;  or,  in  rupture,  if  animals  travel  about 
very  much,  there  soon  occurs  necrosis  of  the  tissues  of  the 
anterior  fetlock  region  and  the  condition  is  rendered  in- 
curable. Cases  are  reported  of  animals  that  have  suffered  rup- 
ture of  the  long  digital  extensor  and  the  subjects  learned  to 
throw  the  member  forward  during  extension,  substituting  for 
the  extensor  tendon  the  pendulum-like  momentum  which  the  foot 
affords  when  so  employed;  and  a  walking  and  even  a  trotting 
pace  was  possible  without  doing  injury  to  the  fetlock  region. 

Where  a  subcutaneous  division  exists  as  in  rupture,  the  di- 
vided ends  of  the  tendon  may  ])e  definitely  recognized  liy  palpa- 
tion. 

Treatment. — Subjects  are  l)est  put  in  slings  and  k('i)t  so  con- 
fined until  regeneration  of  tendinous  structures  has  been  com- 


LAMENESS  IN  THE  HIND  LEG  255 

pleted.  This  requires  from  six  weeks  to  two  months'  time.  In 
addition,  the  extremity  is  kept  in  a  state  of  extension  by  means 
of  suitabk-  si)lints  ;uid  shoes, — a  shoe  equipped  with  an  exten- 
sion at  the  toe  and  perforated  so  that  a  steel  l)raee  may  be  hooked 
into  the  perforation  and  the  brace  fashioned  to  be  buckled  to 
the  upper  metatarsal  region.  When  braces  are  placed  in  front 
of  the  foot,  great  care  is  necessary  in  properly  padding  the  mem- 
ber with  cotton  lest  sloughing  from  pressure  occurs  at  the  coro- 
net ;  but  this  does  not  apply  in  rupture  of  extensors  so  nuich 
as  where  flexors  are  ruptured. 

Open  wounds  are  treated  along  general  surgical  lines,  dressed 
as  frequently  as  occasion  demands,  and  recovery  will  ]:e  complete 
in  a  few  months'  time  unless  much  of  the  tendon  has  been  de- 
stroyed. In  one  instance,  the  author  had  occasion  to  observe 
such  a  condition,  which,  because  of  the  extensive  destruction 
of  tendon  and  lack  of  facilities  for  giving  proper  attention  to 
the  subject,  results  were  so  unfavorable  that  it  was  deemed 
necessary  to  destroy  the  animal. 

Wounds  From  Interfering. 

When,  during  locomotion,  injury  is  inflicted  upon  the  mesial 
side  of  an  extremity  by  the  swinging  foot  of  the  other  member, 
the  condition  is  termed  interfering. 

Etiolog-y  and  Occurrence. — Faulty  conformation,  bad  shoe- 
ing and  over-work  are  the  prineipal  causes  of  interfering. 
Horses  that  are  'M)ase  narrow"  or  that  have  crooked  legs  are 
quite  apt  to  interfere.  Shoes  that  are  put  on  a  foot  that  is  not 
level  or  applied  in  a  twisted  position,  or  shoes  wide  at  the  heel 
will  often  cause  interfering  and  injury.  Animals  that  are  driven 
at  fast  work  until  they  become  nearly  exhausted  may  be  expected 
to  interfere.  Such  cases  are  frequently  observed  in  \oung  horses 
that  are  driven  over  rough  roads,  particularly  when  so  neai'ly 
•exhausted  or  weakened  from  disease  or  inanition  that  the  feet 
are  dragged  forward  rather  than  picked  up  and  advanced  in 
the  normal  manner. 

Symptomatology.— Wounds  inflicted  by  striking  the  extrem- 
ities  in  this  manner  present  various  appearances  and  occasion  dis- 


256  LAMENESS  OF  THE  HORSE 

similar  manifestaticns.  The  hind  legs  are  almost  as  frequently 
affected  as  the  front  and  the  fetlock  region  is  most  often  injured, 
though  wounds  may  be  inflicted  to  the  coronet.  In  front,  the 
carpus  is  sometimes  the  site  of  injury. 

When  only  an  abrasion  is  caused,  little  if  any  lameness  oc- 
curs, but  where  interfering  is  continued  and  nerves  are  involved 
or  subfascial  infection  and  extensive  inflammation  succeed  such 
abrasions,  marked  lameness  and  evidence  of  great  pain  are  mani- 
fested. Frequently,  in  chronic  eases  affecting  the  hind  leg,  the 
fetlock  a.ssumes  large  proportions,  and  at  times  during  the  course 
of  every  drive  the  subject  strikes  the  niflamed  part,  immediately 
flexing  and  abducting  the  injured  member,  and  the  victim  hops 
on  the  other  leg  until  pain  has  somewhat  subsided. 

Interfering  is  much  more  serious  in  animals  that  are  used  at 
fast  work  than  in  draft  horses.  In  light-harness  or  saddle  horses, 
it  may  render  the  subject  practically  valueless  or  unserviceable 
if  the  condition  cannot  be  corrected. 

Treatment. — AVherever  possible,  cause  is  to  be  removed  and 
if  animals  are  properly  used,  ordinary  interfering  wounds  will 
yield  to  treatment.  If  the  shoeing  is  faulty,  this  should  be  cor- 
rected, the  foot  properly  prepared  and  leveled  before  being  shod 
and  suitable  shoes  applied.  In  young  animals  that  become  "leg- 
weary  ' '  from  constant  overwork,  rest  and  recuperation  are  neces- 
sary to  enhance  recovery.  In  such  cases  it  will  be  found  that 
very  light  shoes,  frequently  reset,  will  tend  to  prevent  injury  to 
the  fetlock  region  such  as  characterizes  these  injuries  of  hind 
legs. 

Palliative  measures  of  various  kinds  are  employed  where 
cause  is  not  to  be  remioved  and  a  degree  of  success  attends 
such  effort.  In  draft  horses  or  animals  that  are  used  at  a  slow 
pace,  shields  of  various  kinds  are  strapped  to  the  extremity 
and  protection  is  thus  afforded.  Or,  large  encircling  pads  of 
leather,  variously  constructed,  serve  to  cause  the  subject  to 
walk  with  the  extremities  apart. 

Interfering  shoes  of  different  types  are  of  material  benefit  in 
many  instances.  Often  the  principle  upon  which  corrective  shoe- 
ing is  based  is  that  the  mesial  (inner)  side  of  the  foot  is  too 
lew;  the  foot  is  consequently  leveled  and  the  innci-  l)ranch  of  the 


LAMENESS  IN  THE  HIND  LEG  257 

shoe  is  made  thicker  than  the  outer,  altering  the  position  of  the 
foot  in  this  way.  This  is  productive  of  desirable  results.  How- 
ever, much  depends  upon  the  manner  in  which  the  foot  in  motion 
strikes  the  weight-bearing  member  as  to  the  corrective  measures 
that  are  indicated.  This  belongs  to  the  domain  of  pathological 
shoeing  and  the  reader  is  referred  to  works  on  this  subject  for 
further  study  of  this  phase  of  lameness. 

Lymphangitis. 

Excluding  glanders,  in  the  majority  of  instances,  lymphangitis 
in  the  horse,  such  as  frequently  affects  the  hind  legs,  is  due  to 
the  local  introduction  of  infectious  material  into  the  tissues  as 
a  result  of  wounds.  However,  one  may  observe  in  some  instances 
an  acute  lymphangitis  which  affects  the  pelvic  limbs  of  horses 
and  no  evidence  of  infection  exists.  Consequently,  lymphangitis 
may  be  considered  as  infectious  and  non-infectious. 

INFECTIOUS    LYMPHANGITIS. 

Etiolog"y  and  Occurrence. — Traumatisms  of  the  legs  fre- 
quently result  in  infection  and  when  such  injuries  are  near 
lymph  glands,  even  though  the  degree  of  infection  be  slight, 
more  or  less  disturbance  of  function  of  the  muscles  in  the  vicinity 
of  such  glands  occurs  and  lameness  follows. 

The  prescapular,  axillary  and  cubital  lymph  glands  when  in  a 
state  of  inflammation,  cause  lameness  of  the  front  leg,  and  the 
superficial  inguinal  and  deep  inguinal  lymph  glands  not  infre- 
quently become  involved  also.  Because  of  the  location  of  these 
lymph  glands,  they  are  subject  to  comparatively  fre(|uent  injury 
and  inflammation,  causing  lameness  more  often  than  other  lynipli- 
gland-affections. 

Small  puncture  wounds  in  the  region  of  the  elbow  are  often 
met  with.  These  may  be  inflicted  when  horses  lie  down  ui)nn 
sharp  stumps  of  vegetation  or  shoe-calk  injuries  nuiy  be  the 
means  of  introducing  contaginm,  and  an  infectious  inflammation 
results.  A])scess  formation,  the  result  of  strangles  or  other  in- 
fection in  the  prescapular  glands,  may  l)e  observed  at  times. 
Following  castration,  the  inguinal  lymph  glands  may  ])ecome 
involved  in   an  infectious  inflannnation  and  locomotion   is  im- 


258  LAMENESS  OF  THE  HORSE 

peded  to  a  marked  degree.  Horses  running  at  pasture  sometimes 
become  injured  by  trampling  upon  pieces  of  wood,  causing  one 
end  of  these  or  of  various  implements  to  become  embedded  in  the 
soft  earth  and  the  other  end  to  enter  at  the  inguinal  region  and 
even  penetrate  the  tissues  to  and  through  the  skin  and  fascia  just 
below  the  perineal  region. 

Nail  punctures  resulting  in  infection  frequently  cause  an  in- 


Fig-.  61 — Chronic  lymphangitis.     Showing  hypertropliy  of  the  left  hind  leg, 
due  to  repeated  inflammation. 

fectious  lymphangitis  and  a  marked  and  painful  swelling  of  the 
legs  supervenes. 

Symptomatology. — Lameness,  mixed  or  swinging-leg,  signal- 
izes the  presence  of  acute  lymphangitis.  There  is  always  more 
or  less  swelling  present  and  manipulation  of  the  affected  parts 
gives  pain  to  the  subject.  Depending  upon  the  character  of  the 
infection  and  its  extent,  there  is  presented  a  varying  degree  of 
constitutional  disturbance.  There  may  be  a  rise  in  temperature 
of  from  two  to  five  degrees,  and  in  sucli  instances  tliere  is  an 
accelerated  pulse.  Where  nnich  intoxiccition  is  present,  anorexia 
and  dipsosis  are  to  be  noticed. 


LAMENESS  IN  THE  HIND  LEG 


259 


Swelling  may  increase  gradually  and  in  time  discharge  of  pus 
may  take  place  spontaneously  without  drainage  being  provided 
for,  if  the  character  of  the  infection  does  not  cause  early  death. 


Fig.  62 — Elephantiasis. 


In  these  cases  lameness  is  pronounced  and  the  cause  of  the  dis- 
turbance is  to  be  sought,  particularly  if  the  condition  be  due  to 
a  nail  puncture. 

Treatment. — Location  of  the  site  of  injury  is  advisable  in 


260  LAMENESS  OF  THE  HORSE 

all  cases  and  in  some  instances  provision  for  drainage,  as  in 
puncture  wounds,  is  helpful.  Locally,  curettage  and  the  j.ppli- 
cation  of  suitable  antiseptics  are  indicated.  Hot  fomentations 
are  beneficial  and  should  be  continued  for  several  days  if  neces- 
sary, to  stimulate  resolution.  A  brisk  purge  should  be  admin- 
tered  at  the  onset  and  strychnin,  because  of  its  indirect  stimu- 
lative effect  upon  the  circulation  together  with  its  tonic  effect 
upon  the  musculature,  is  beneficial. 

In  all  such  cases  rational  treatment,  good  hygiene  and  careful 
nui*sing  are  the  principal  factors  which  stimulate  recovery.  In- 
dividual resistance  or  lowered  vitality  has  a  marked  influence 
on  the  course  of  this  affection. 

NON-INFECTIOUS    LYMPHANGITIS. 

This  type  of  lymphangitis  is  associated  with,  or  the  result  of, 
a  derangement  of  digestion.  It  affects  heavy  draft  horses,  rarely 
other  types  of  animals,  and  involves  one  or  both  hind  legs. 

Occurrence. — In  healthy  and  well  nourished  horses  irregu- 
larly used,  this  affection  may  suddenly  manifest  itself.  It  oc- 
curs in  singular  instances  in  mares  that  are  in  advanced  preg- 
nancy even  when  such  animals  are  at  pasture.  Usually,  however, 
this  malady  is  found  in  heavy  draft  horses  that  have  been  kept 
stabled  from  one  to  three  days. 

Symptomatology. — At  the  outset  in  severe  cases,  there  is 
elevation  of  temperature,  labored  breathing,  accelerated  pulse, 
anorexia  and  more  or  less  swelling  of  the  affected  memliers. 
Swelling  is  very  painful  and  when  the  affected  legs  are  palpated, 
pain  is  manifested  by  flinching.  The  inguinal  lymph  glands 
are  often  swollen  but  in  some  cases  they  are  not  affected  in  any 
perceptible  degree.  In  the  average  case  suppuration  does  not 
occur  and  when  conditions  are  favorable,  resolution  is  complete 
within  ten  days.  Tlie  extent  of  the  involvement  and  the  intensity 
of  the  affection  vary  materially  in  different  cases  and  a  chronic 
lymphangitis  may  succeed  the  acute  attacks  and  finally  in 
some  instances,  elei)liantiasis  results. 

Treatment. — An  active  purgative  should  be  given  at  once 
and  in  the  ordinary  case,  stimulants  are  indicated.  If  marked 
distress  is  present,  morphin  is  given  and  where  there  is  much 


LAMENESS  IN  THE  HIND  LEG  261 

rise  of  temperature,  cold  drinking  water  is  offered  in  abundance 
and  catharsis  is  enhanced  by  enemata.  Locally,  hot  appli- 
cations are  of  benefit.  Hot  towels  or  cotton  held  in  position 
ny  l)andages  and  kept  soaked  with  warm  water  will  relieve  pain 
and  stimulate  resolution.  Diuretics  may  be  of  benefit  and  ano- 
dyne applications  are  to  be  employed  with  profit  in  some  cases. 
Walking"  exercise,  if  not  indulged  in  to  excess,  is  helpful  as  soon 
as  acute  inflammation  has  subsided.  By  giving  careful  attention 
to  the  regimen  and  providing  regular  exercise  for  susceptible 
hubjects,  this  type  of  lymphangitis  is  often  forestalled. 


INDEX 


A 

\cetabuUini     185 

Acute   arthritis   65 

Acute  laminitis 162 

Acute   tendinitis   135 

Affertions  of  blood   vessels 31 

Affections  cf  bursae  and  thecae  27 

Affections  of  the  feet 34 

Affections   of    ligaments 20 

Affections  of  lymph  vessels  and 

glands 32 

Affectioi  s   of   muscles   and   ten- 
dons      28 

Affections   of   nerves 30 

Anamnesis    38 

Anatomo-physiological      review 

of   parts   of   fore   leg 55 

Anatomo-physiological      consid- 
eration  of  the  pelvic   limbs..! 85 
Anatomv  of  the  joint  capsule. .220 

Annular    ligament    58 

Antea-spinatus    muscle    65 

Anterior     brachial     revion, 

wounds    of    90 

Anterior     digital      extensor 

muscle    193 

Arteritis    209 

Arterv     (brachial),    thrombosis 

of    the    SI 

Arthritis 22,  84 

Arthritis,    acute    65 

Arthritis,  chronic  65 

Arthritis,  infectious  66 

Arthritis,    metastatic    25 

Arthritis  of  the  fetlock  joint....!  52 

Arthritis,   rheumatic   26 

Arthritis,   scapulohumeral   65 

Arthritis,    tarsal    225 

Arthritis,    traumatic 22 


Articular    ringbone 121 

Articulation,    femeropelvic    1S5 

Articulation,     m  e  t  a  carpophal- 

angeal     5S 

Articulation,    scapulohumeral ..  55 
Aspiration-and-injection     treat- 
ment   of   bog    spavin... 241 

Aspiration-and-injection     treat- 
ment of   capped  hock 252 

Aspiration-and-injection     treat- 
ment   of    thoroughpin 250 

Astragalus  190 

Astragalus,  fracture  of  the 230 

Attitude  of  the   subject 41 

Atrophy      of      the      quadriceps 

muscles    205 

Atrophy,  shoulder  73 

B 

Biceps  brachii  58,  65,  68,  69 

Bicipital    bursa,     inflammation 

of  68 

Blood  vessels,  affections  of 3! 

Bog  spavin   242 

Bog    spavin,    aspiration-and-in- 
jection  treatment   of .244 

Bog  spavin,  line  firing  for 246 

Bog  spavin,  vesication  for 246 

Bone  spavin 235 

Bones,  degenerative  changes  in  16 

Bones,   tarsal   190 

Bossi's    double    tarsal    neurec- 
tomy    242 

Brachial   artery,   thrombosis   of 

the  81 

Brachial   paralvsis  77 

Bursa    intertubercularis    62.  69 

Bursa    podotrochlearis,    inflam- 
mation of  the 157 

Bursae,  affections  of 27 


LAMENESS  OF  THE  HORSE 


Bursitis  27,  l04 

Bursitis,    infectious    28 

Bursitis  in  tlie  fetlock  region.. ..150 

Bursitis   intertubercularis   68 

Bursitis,    noninfectious    28 

C 

Calcaneocuboid    ligaments    190 

Calcaneo-metatarsal  ligaments. .190 

Calcaneum,  fracture  of  the 230 

Calk  wounds 170 

Capped   hock    .....251 

Capped  hock,  aspiration-and-in- 

jection   treatment   of 252 

Capsular  ligament 190 

Caput  muscles  71 

Carpal  bones,  fmcture  of  the..  96 
Carpal  bones,  huation  of  the....  96 
Carpal    flexors,    contraction    of 

the  93 

Carpal  flexors,  inflammation  of 

the  93 

Carpal  joint  58 

Carpal   joint,  open 100 

Carpitis 98 

Carpus,   inflammation   of  the....  98 
Cartilage,      lateral,      inflamma- 
tion  of 1 74 

Cartilages  of  the  third  phalanx, 

ossification  of  the 155 

Chronic   arthritis   65 

Chronic  gonitis  217 

Chronic  laminitis   164 

Chronic   tendinitis   137 

Cochran      shoe      for      dropped 

soles   169 

Collateral    ligaments   190 

Comminuted    fractures   17 

Compound    fractures    17 

Contracted    tendons    of    foals. ...143 
Contrat  tion  of  the  carpal  flexors  93 
Contraction    of   the    flexor    ten- 
dons     137 

Contusions    of   the   triceps 
brachii   71 


Contusive   wounds   85 

Coracoradialis    58 

Corns    172 

Coronary     region,     wounds     of 

the  170 

Corpora  oryzoidea 218 

Cotyloid    ligament   185 

Courbe   233 

Crepitation,   false  48 

Crepitation,  true  47 

Crucial  ligaments  188 

Crural  nerve,  paralysis  of  the. .204 

Cunean  bursa  237 

Cunean  tenotomy  242 

Cuneiform    magnum    191 

Cuneiform   medium   191 

Curb   233 

D 

Deep   digital    flexor,   distension 

of  the   tarsal   sheath   of 246 

Deep  flexor  tendon  (perforans)   60 
Degenerative  changes  in  bones  16 

Diagnosis    by    exclusion 53 

Diagnosis    by    use    of    the    X- 

ray 179 

Diagnostic   principles    37 

Disease,  navicular 157 

Dislocations    21 

Distension    of   the   tarsal   joint 

capsule  242 

Distension  of  the  tarsal  sheath 

of  the  deep  digital  flexor 246 

Division     of     long    digital    ex- 
tensor  253 

Dorsal   ligaments   190 

Dropped  elbow  71,  80 

Dropped  soles,  shoe  for 169 

Dropped   stifle   205 

Dry    spavin    225 

E 

Elbow,    dropped    71,  80 

Elbow,   inflammation  of  the 84 


INDEX 


Elbow  joint  58 

Elephantiasis  34 

Etiology,  general  discussion  of  15 

Examination  by  palpation 43 

Examination,    special    methods 

of  53 

Examination,   visual    39 

Exclusion,    diagnosis    by 53 

Exostosis  of  splint  bones 107 

Exostosis,   phalangeal   118 

Extensor  ( long  digital )  rupture 

and  division  of 253 

Extensor  of  the  digit,   rupture 

of  145 

Extensor   pedis   60 

Extensor  pedis,  rupture  of 145 

Extensor  pedis,  rupture  and  di- 
vision of  253 

F 

False   crepitation    48 

Feet,  affection  of  the 34 

Femoral     nerve,     paralysis     of 

the  204 

Femeropatella  ligaments  188 

Femeropelvic  articulation  185 

Femur  185,  192 

Femur,    fracture    of    the 199 

Femur,  luxation  of  the 201 

Fetlock  joint  58 

Fetlock  joint,  arthritis  of  the....l52 
Fetlock  joint,  luxation  of  the..l25 

Fetlock   joint,   open 110 

Fetlock     region,     thecitis     and 

bursitis  in 148 

Fetlock,  shoe  for  bracing  the.. ..181 
Fibular  tarsal  bone,  fracture  of 

the  230 

Firing,    treatment    of    ringbone 

by  123 

First   phalanx   59 

"Fish   knees"  145 

Fixed  luxations  21 

Fixed  patellar  disarticulation. .213 
Flexor  brachii  58,  68,  69 


Flexor  carpiradialis  93 

Flexor  carpiulnaris  93 

Flexor  metacarpi  externus 94 

Flexor   metacarpi   internus 93 

Flexor    metacarpi    medius 93 

Flexor    metatarsi    193 

Flexor,   superficial   digital 194 

Flexor  tendons,   contraction  of 

the  137 

Flexor    tendons,    inflammation 

of  the  135 

Flexor  tendons,  rupture  of 146 

Flexors     of     phalanges,     open 

sheath    of    124 

Foals,   contracted  tendons  of.. ..143 

Forearm,   wounds  of 90 

Fore   leg,   lameness   in  the 55 

Fracture  of  the  carpal  bones....  96 

Fracture  of  the  femur 199 

Fracture   of   the    libular    tarsal 

bone    230 

Fracture    of    first    and    second 

phalanges    131 

Fracture   of   humerus 82 

Fracture   of   the   ilium 198 

Fracture   of  the   ischial    tuber- 
osity    199 

Fracture  of  the  metacarpus 106 

Fracture  of  the  patella 212 

Fractures  of  the  pelvic  bones..l96 
Fracture  of  the  proximal  sesa- 
moids    128 

Fracture   of  the   pubis 197 

Fracture  of  the  radius 87 

Fracture   of   the   scapula 62 

Fracture    of    t'he    tibia 222 

Fracture    of    the    tibial    tarsal 

bone 230 

Fracture  of  the  ulna 86 

Fractures    16 

Fractures,    comminuted    17 

Fractures,    compound    17 

Fractures,   green   stick 18 

Fractures,  impacted  19 

Fractures,    longitudinal    18 


LAMENESS  OF  THE  HORSE 


Fractures,   multiple   .._ IS 

Fractures,      multiple      longitu- 
dinal    19 

Fractures,   oblique   18 

Fractures,  simple  17 

Fractures,   simple   transverse....  IS 

Fractures,    transverse   18 

Fragilitas    199 

Fragilitas  osseum 128 

G 

Gait,   observing  character   of....  4S 

Gastrocnemius  194 

Gluteal  tendo-synovitls  203 

Gluteus  medius  muscle 192,  203 

Gonitis,    chronic 217 

Green  stick   fractures IS 

H 

Hind  leg.  lamenoss  in  the ISo 

Hind  leg,  paralysis   of  the 204 

Hip    lameness    195 

Hip    swinney 205 

Hock,  capped  251 

Hock   joint  1S8 

Hoof    testers    53 

Humeroradioulnar  joint  58 

Humerus,   fracture  of 82 

I 

Iliac  thrombosis  209 

Iliopsoas    204 

Ilium,   fracture   of  the 198 

Impacted    fractures    19 

Infectious  arthritis 66 

Infectious  bursitis  28 

Infectious  inflammation  of  the 

lateral    cartilage    173 

Infectious  lymphangitis  257 

Infectious  synovitis  124 

Inflammation    of    the    bicipital 

bursa  68 

Inflammation      of     the     bursa 

podotrochlearis   157 


Inflammation     of     the     carpal 

flexors  93 

Inflammation  of  the  carpus 98 

Inflammation  of  the  elbow 84 

Inflammation  of  the  flexor  ten- 
dons  125 

Inflammation  of  posterior  liga- 
ments of  pastern 129 

Inflammation  of  proximal  sesa- 
moid bones  12 1 

Inflammation  of  third  sesamoid 

and  deep  flexor  tendon 157 

Inflammation    of    the    trochan- 
teric bursa  -^^ 

Infraspinatus    muscle    6o 

Injection  of  fluids  for  quittor....l77 
Injuries       to      scapulohumeral 

joint   6^ 

Interfering,    shoeing    for 256 

Interfering,   wounds  from 255 

Ischial    tuberosity,    fracture    of 
the  199 


Joint  capsul'^.  anatomy  of  the..220 

Joint,    carpal    58 

Joint,  elbow  58 

Joint,   fetlock   58 

Joint  capsule,  tarsal,  distension 

of  the  242 

Joint,  fetlock,  arthritis  of  the....!  52 

Joint,    fetlock,    luxation    of 125 

Joint,    hock    18^ 

Joint,   humeroradioulnar   58 

Joint,  open  67 

Joint,  open  carpal 100 

Joint,    open    fetlock 110 

Joint,    pastern    proximal    inter- 

phalangeal  129 

Joint,   shoulder   55 

Joint,    stifle,    open 220 

Joint,  tarsal,  open 229 


INDEX 


L 

Lameness,  hip  1!)5 

Lameness,   mixed   49 

Lameness  in  the  fore  leg 55 

Lameness  in  the  hind  leg 185 

Lameness,  shoulder  61 

Lameness,    supporting-leg    49 

I  fimeness,    swinging-leg   49 

Laminitis  160 

Laminitis,  acute  162 

Laminitis,  chronic   164 

Lateral  cartilage,  infectious  in- 
flammation of  the 174 

Lateral    cartilages,    ossification 

of  155 

Ligaments,  affections  of 20 

Ligament,   capsular 190 

Ligaments,    collateral   - 190 

Ligament,    cotyloid    185 

Ligaments,  crucial  188 

Ligaments,    dorsal    190 

Ligaments,    femeropatella   188 

Lisament,  medial  190 

Ligaments,     mesial     tarsal, 

sprains  of  the 232 

Ligaments  of  pastern  proximal 
interphalangeal  joint,  inflam- 
mation  of   129 

Ligaments,  patellar  188 

Ligaments,    plantar    190 

Ligament,    pubiofemoral    185 

Ligament,  superior  check 58 

Ligament,    suspensory,   rupture 

of    146 

Ligaments,   volar   129 

Ligament,  volar-carpal  or  an- 
nular    58 

Ligation  of  the  saphenous  vein. .246 

Line  firing  for  bog  spavin 246 

Longitudinal  fractures  IS 

Lumbosacral  plexus  204 

Luxation  of  the  carpal  bones....  96 

Luxation   of   the   femur 201 

Luxation  of  fetlock  joint 125 

Luxation    of    the    patella 213 


Luxation    cf    the    patella,    out- 
ward   215 

Luxation    of    the    patella,    up- 
ward    214 

Luxation      of      scapulohumeral 

joint    67 

Luxations    21 

Luxations,   fixed   21 

Luxations,    temporary    21 

Lymph  vessels  and  glands,  af- 
fections  of  32 

Lymphangitis    32 

Lj'mphangitis,  infectious  257 

Lymphangitis,    non-infectious..260 

M 

Medial  ligament  190 

Median    neurectomy    124 

Mesial  tarsal  ligaments,  sprains 

of  the  232 

Metacarpophalangeal     articula- 
tion    58 

IMetacarpus,  fracture  of  the 106 

Metastatic  arthritis  25 

Mixed    lameness    49 

Momentary  patellar  disarticula- 
tion   213 

;Movements,  passive  47 

Multiple   fractures   18 

Multiple  longitudinal  fractures..  19 

Muscles,   affections  of 28 

Muscle,   antea-spinatus  65 

Muscle,     anterior     digital     ex- 
tensor   193 

Muscle,   biceps   brachii 58 

;\Iuscle,  caput  71 

Muscle,  gluteus  medium. ...192,  203 

Muscle,   infraspinatus  65 

Muscle,  peroneus  tertius 193 

Muscle,    postea-spinatus   65 

Muscles,    quadriceps    193 

Muscles,     quadriceps,     atrophy 

of    the    205 

Muscle,   subscapularis  65 

Muscle,  supraspinatus  65 


LAMENESS  OP  THE  HORSE 


IMuscle,    tibialis   anticus 193 

Muscle,  triceps  brachii 58 

Myalgia   195 

N 

Nail  punctures 178 

Navicular  disease 157 

Nerves,  affections  of 30 

Nerve,     femoral,     paralysis     of 

the  204 

Nerve,    obturator,    paralysis    of 

th°  - 206 

Nerve,      sciatic,      paralysis     of 

the  208 

Nerve,      (suprascapular)      par- 
alysis   of   the 75 

Non-infectious    lymphangitis    ..260 

Non-infectious  bursitis  28 

Neurectomy,      Bossi's      double 

tarsal    242 

Neurectomy,  median  124 

Neurectomy,  plantar  124 

O 

Oblique  fractures  18 

Observing  character  of  gait 48 

Obturator    nerve,    paralysis    of 

the  206 

Occurrence,   general   discussion 

of  15 

Omphalophlebitis  25 

Open    carpal    joint 100 

Open   fetlock  joint 110 

Open    joint   67 

Open  sheath  of  flexors  of  pha- 
langes   124 

Open  stifle  joint 220 

Open   tarsal  joint 229 

Os  corona  60 

Ossification  of  cartilages  of  the 

third  phalanx 155 

Ossification      of      the      lateral 

cartilages 155 

Os    innominatum    196 

Os   suffraginis   59 


Osteitis,   rarefying 16 

Outward    luxation    of    the    pa- 
tella     215 

P 

Palpption,  examination  by 43 

Paralvsis.  brachial  77 

Paralysis  of  the  femoral  nerve. .204 

Paralvsis    of   the    hind    leg 204 

Paralysis      of      the      obturator 

nerve    - 206 

Paralvsis  of  the  sciatic  nerve... .208 
Paralysis  of  the  suprascapular 

nerve    75 

Paralysis,    radial    77 

Paronychia  170 

Passive  movements 47 

Pastern       proximal      interpha- 

langeal  joint,  inflammation  of 

ligaments    of    129 

Patella   - 18S 

Patella,  fracture  of  the 212 

Patella,    luxation    of    the 213 

Patella,     outward     luxation     of 

the  215 

Patella,     upward     luxation     of 

the  214 

Patellar  disarticulation,  fixed.. ..213 
Patellar  disarticulation,  mo- 
mentary   21 3 

Patellar  ligaments   188 

Pelvic  bones,  fractures  of  the. .196 
Pelvic    limbs,    anatomo-physio- 

logical  consideration  of  the....l85 

Penetrative  wounds  85 

Periarticular   ringbone   122 

Peroneus  fortius  muscle 193 

Phalangeal  exostosis  118 

Phalanges,  fracture  of  first  and 

second  131 

Phalanges,      open      sheath      of 

flexors  of  124 

Phalanx,    first    59 

Phalanx,   second   60 

Phalanx,    third,    ossification    of 

cartilages  of 155 


INDEX 


Plantar   ligaments   190 

Plantar  neurectomy  124 

Polyarthritis    25 

Postea-spinatus  muscle  65 

Principles,   diagnostic   37 

Proximal    sesamoid    bones,    in- 
flammation of    127 

Proximal     sesamoids,     fracture 

of  - 128 

Pubiofemoral  ligament  185 

Pubis,   fracture   of  the 197 

Punctures,  nail 178 

Q 

Quadriceps  muscles  193 

Quadriceps  muscles,  atrophy  of 

the    205 

Quittor  174 

Quitter,  injection  of  fluids  for.. ..177 

R 

Rachitic  ringbone  122 

Radial    paralysis    77 

Radius,  fracture  of  the 87 

Rarefying  osteitis  16 

Rheumatic  arthritis  26 

Rheumatism  196 

Ringbone  118 

Ringbone,  articular  121 

Ringbone,   periarticular   122 

Ringbone,   rachitic  122 

Ringbone,   traumatic  122 

Ringbone  treated  by  flring 123 

Roberts    shoe    for    bracing    the 

fetlock    181 

Rupture  of  the  extensor  pedis. .145 
Rupture  of  flexor  tendons  and 

suspensory  ligament  146 

Rupture     of    long    digital     ex- 
tensor   253 

Rupture  of  the  tendo  archillis..224 

S 

Saphenous     vein,     ligation     of 
the    246 


Scapula,  fracture  of  the 62 

Scapulohumeral  articulation  ....  55 
Scapulohumeral   joint,    injuries 

to  66 

Scapulohumeral  joint,  luxation 

of  67 

Scapulohumeral    joint,    wounds 

of  67 

Scapulohumeral  arthritis 65 

Sciatica   208 

Sciatic  nerve,  paralysis  of  the. .208 

Second  phalanx  60 

Sesamoid  bones  59 

Sesamoid,    third,    inflammation 

of  the 157 

Sesamoids,    proximal,    fracture 

of  128 

Sesamoiditis  127 

Setons  75 

Sheath  of  flexors  of  phalanges, 

open    124 

Sheath     (tarsal)     of    the    deep 

digital    flexor,    distension    of 

the    246 

Shoe  for  dropped  soles 169 

Shoeing  for  interfering 256 

Shoulder  atrophy  73 

Shoulder  joint  55 

Shoulder  lameness  61 

Simple    fractures    17 

Simple    transverse    fractures....  18 

Soles,  dropped,  shoe  for 169 

Spavin,    bog   242 

Spavin,   bone   235 

Spavin,    dry   225 

Spavin    test    239 

Special    methods    of    examina- 
tion    53 

Sprains    of    the    mesial    tarsal 

ligaments    232 

Sprains,    tarsal    232 

Splints  107 

Spring-halt    225 

Stifle,  dropped  205 

Stifle    joint,    open 220 


LAMENESS  OF  THE  HORSE 


Strangles     25 

Streptococcus   equi  25 

String-halt  225 

Subject,  attitude  of  the 41 

Subscapularis   muscle   65 

Supporting-leg-lameness    49 

Suprascapular  nerve,  paralysis 

of    the    75 

Supraspinatus  muscle  65 

Superficial    digital    flexor 194 

Superior  check  ligament 58 

Suspensory    ligament,    rupture 

of  146 

Sweeny    "73 

Swinging-leg-lameness  49 

Swinney  73 

Swinney,  hip  205 

Synovial    distension    of    tendon 

sheaths  104 

Synovitis  25 

Synovitis,   infectious  124 

T 

Tarsal    arthritis    225 

Tarsal   bones   190 

Tarsal  joint  capsule,  distension 

of    the    242 

Tarsal  joint,   open 229 

Tarsal     sheath     of     the     deep 
digital    flexor,    distension    of 

the    246 

Tarsal  sprains  232 

Tarsus  192 

Temporary    luxations    21 

Tendinitis  135 

Tendinitis,    acute    135 

Tendinitis,    chronic    137 

Tendo     achillis,     rupture     and 

wounds    of    the 224 

Tendon,  deep  flexor,  inflamma- 
tion of  the 157 

Tendon,      deep      flexor       (per- 

forans)  60 

Tendon,    extensor,    rupture    of. .145 


Tendon,    flexor,    rupture   of ..146 

Tendons  of  foals,   contracted.... 143 
Tendon    sheaths,    synovial    dis- 
tension   of    104 

Tendons,    affections    of 28 

Tendons,   flexor,  contraction  of 

the    137 

Tendons,    flexor,    inflammation 

of    the 135 

Tendo-synovitis,   gluteal  203 

Tenotomy,   cunean   242 

Tensor  fascia  lata 192 

Test,  spavin  239 

Testers,   hoof  53 

Thecae,  affections  of 27 

Thecitis    27,  104 

Thecitis  in  the  fetlock  region... .150 

Thoroughpin    246 

Thoroughpin,  aspiration-and-in- 

jection  treatment   of 250 

Thrombosis,  iliac   209 

Thrombosis     of     the     brachial 

artery  81 

Tibia  ..-- 188 

Tibia,    fracture   of   the 222 

Tibial  tarsal  bone,   fracture  of 

the  : 230 

Tibialis  anticus  muscle 193 

Tibioastragular     joint,     disten- 
sion of  the 242 

Transverse    fractures    18 

Traumatic  arthritis  22 

Traumatic  ringbone  122 

Treatment    of    bog    spavin    by 

aspiration    and    injection 244 

Treatment   of   capped    hock   by 

aspiration    and    injection 252 

Treatment    of   ringbone   by   fir- 
ing   123 

Treatment    of    thoroughpin    by 

aspiration    and    injection 250 

Triceps  brachii   58 

Triceps  brachii,  contusions  of..  71 
Triceps  extensor  brachii 71 


INDEX 


Trochanteric   bursa,    inflamraa- 

tion   of  the 204 

True  crepitation 47 

U 

Ulna,  fracture  of  the 86 

Ulnaris    lateralis 94 

Upward  luxation  of  the  patella.. 214 


Vein,     saphenous,     ligation     of 

the    246 

Vesication    for   bog   spavin 246 

Vessignon  cheville 246 

Visual  examination  39 


Volar   ligaments   129 

W 

Wounds,  calk i7o 

Wounds,    contusive    85 

Wounds   from    interfering 255 

Wounds    of    anterior    brachial 

region    90 

Wounds  of  coronary  region 170 

Wounds      of      scapulohumeral 

joint    67 

Wounds  of  tendo  achillis 224 

Wounds,    penetrative    So 


Volar-carpal  ligament 


58      X-ray  diagnosis 179 


AUTHORITIES    CITED 


Almy,  J 

141,  200,  202,  208,  212,  216,  214,  233 

Bassi 215 

Bauman,    S.    H 197 

Bell,    Roscoe   R. 69 

Benard  216 

Berns,    Geo.    H 77,  218 

Bouley    225 

Bourdelle    147 

Cadiot,  P.  J....78,  141,  200,  202,  208, 

212,  214,  216,  223,  225,  233,  245,  250 

Campbell,  D.  M 162,  166,  167 

Castagne   - 84 

Cochran,  David  W 169,  170 

Diekerhoff  237 

Dollar,  Jno.  A.  W 68,  198 

Eberlein 237 

Fisher,    Carl    W 236 

Frost,    J.    N 113 

Frost,  R.  F 128 

Greaves,  Thomas 157 

Hoare,  E.  Wallis 25,  211,  230 

Hughes,  Joseph 176,  221 

Hutyra  and  Marek 205 

Law,  James  33 


Leblanc 223 

Liautard,    A 84,  199,  238 

Lusk,    Wm.    V 203 

McDonough,   James   237 

Merillat,    Edward   210 

Merillat,  L.  A 80,  96,  175,  210 

Millar,  Thomas  145 

Muller,  H 119,  156,  211,  222 

Montane  147 

Moore,  R.  C 162 

Roberts,  G.  H 181 

Schumacher  215 

Scott,    John    208 

Seeley,  J.  T 176 

Sisson.  Septimus  129,  204,  220 

Smith,   F.,    Major   General 56, 

60,  155,  188,  194 

Strangeways  193 

Taylor,    Henry    71 

Thompson,    H 83,  87 

Trickett,    A 253 

Udall,   D.    H 236 

Uhlrich    224 

Walters,  Wilfred  83,  97 

Williams.   W.   L 217,  236 


Webster  Family  Library  of  Veterinary  Medicine 
Cummings  School  of  Veterinary  Medicine  at 
Tufts  University 
200  Westboro  Road 
Norfhf^rafton,  MA01536 


